{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOHN   F KULL","gend":0,"add":"409 PRINCE OF WALES DR","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1943-02-27","age":"","mstatus":"","insh":"900039757*01","cliId":"8Q85T28KD89","pno":"757\/468-1491","cno":"757\/468-1491","email":"","ename":"","eno":"","pphy":"KILLEN, JOSEPH MD","ppno":"757\/481-2333","pcpadd":"1120 FIRST COLONIAL RD STE 101","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":210216,"pcpname":"Privia - First Colonial Family Practice","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/481-1037","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H61.21","Z72.0","J37.0","R49.0","I71.2","R14.0","R19.7","R14.3","J43.9","Z86.010","Z86.73","H25.13","H40.013","H18.593","H43.813","I63.9","J44.9","I10.","R73.9","E78.5","D04.61","Z20.822","J45.909","D12.4","D12.3","K64.1","K57.30","D48.5","I25.10","K63.5","Z12.11","K57.90","H25.811","H25.11","H26.9","L30.0","L82.1","Z08.","Z85.828","L57.0","H25.012"],"date":["2021-04-07","2021-04-07","2021-04-07","2021-04-07","2021-02-23","2021-05-13","2021-03-31","2021-03-31","2021-03-31","2021-05-17","2021-03-31","2021-05-28","2021-05-28","2021-05-28","2021-05-28","2021-05-27","2021-05-27","2021-05-27","2021-05-27","2021-05-27","2021-03-17","2021-05-13","2021-03-30","2021-05-17","2021-05-17","2021-05-17","2021-05-17","2021-02-17","2021-02-10","2021-05-17","2021-05-17","2021-05-17","2021-07-26","2021-07-26","2021-07-26","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-08-12"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,null,null,null,null,null]}},{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","65862035705","CLOPIDOGREL ","75MG","90","Select","Select",""],["","60505258009","ATORVASTATIN ","40MG","90","Select","Select",""],["","49281012065","FLUZONE ","PF 20-21","-1","Select","Select",""],["","43547035211","LISINOPRIL ","5MG","-90","Select","Select",""],["","69097014260","ALBUTEROL ","HFA","7","Select","Select",""],["","52565005626","TRIAMCINOLON ","0.10%","454","Select","Select",""],["","017478020911","KETOROLAC ","0.50%","10","Select","Select",""],["","062332050503","MOXIFLOXACIN ","HCL 0.5%","3","Select","Select",""],["","060758011905","PREDNISOLONE ","1% OP","5","Select","Select",""],["","33342006015","","75MG","90","Select","Select",""],["","33342006015","CLOPIDOGREL","75MG","90","Select","Select",""],["","49281012065","FLUZONE","PF 20-21","1","Select","Select",""],["","16729004617","ATORVASTATIN","40MG","90","Select","Select",""],["","43547035211","LISINOPRIL","5MG","-90","Select","Select",""],["","52565005626","TRIAMCINOLON","0.10%","454","Select","Select",""],["","69097014260","ALBUTEROL","HFA","-7","Select","Select",""],["","60758011905","PREDNISOLONE","1% OP","5","Select","Select",""],["","62332050503","MOXIFLOXACIN","HCL 0.5%","3","Select","Select",""],["","17478020911","KETOROLAC","0.50%","10","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":""}]}]}