{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MELISSA   A ALBANY","gend":1,"add":"4813 KEMPSVILLE GREENS PKWY","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1979-03-04","age":"","mstatus":"","insh":"1291733*01","cliId":"","pno":"757\/305-6653","cno":"757\/305-6653","email":"","ename":"","eno":"","pphy":"BLACKWOOD, ROBERT MD","ppno":"757\/523-0022","pcpadd":"1201 LAKE JAMES DR STE 200","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23464,"pcpcounty":"","pcpid":210328,"pcpname":"Privia - Blackwood Family Medicine","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/857-4880","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/411-0570","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F43.23","R07.89","K29.70","K25.7","J06.9","Z68.28","R79.89","F41.1","R07.81","M54.12","J40.","R05.","R93.3","R07.9","Z12.11","R10.11","R06.2","F41.9","N64.4","D50.9","D51.9","Z03.818","U07.1","M54.2","R10.811","Z90.49","Z98.84","R07.1","R60.0","F32.9","E53.8","Z01.84","J20.9","N60.11","M79.621","N60.01"],"date":["2021-11-29","2021-01-26","2020-12-15","2021-03-04","2020-01-21","2020-05-20","2020-10-29","2020-11-05","2020-12-09","2020-03-05","2020-03-19","2020-10-29","2020-12-15","2020-12-14","2020-12-14","2020-11-23","2020-11-23","2021-01-26","2021-06-16","2020-01-15","2020-05-21","2020-09-10","2020-09-10","2020-05-20","2020-10-29","2020-10-29","2020-10-29","2020-12-01","2020-12-01","2020-07-24","2020-07-24","2020-04-29","2020-09-09","2021-06-16","2021-06-16","2021-06-16"],"priorHcc":[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":[["","65862052890","VENLAFAXINE","75MG ER","-30","Select","Select",""],["","00185111160","BUPROPION","200MG SR","60","Select","Select",""],["","00093005401","BUSPIRONE","10MG","60","Select","Select",""],["","50111078710","AZITHROMYCIN","250MG","-6","Select","Select",""],["","00406012301","HYDROCO\/APAP","5-325MG","30","Select","Select",""],["","00591292754","LEVALBUTEROL","45\/ACT","15","Select","Select",""],["","29300022019","MONTELUKAST","10MG","30","Select","Select",""],["","59746021106","CYCLOBENZAPR","5MG","90","Select","Select",""],["","65162083366","DICLOFENAC","1%","100","Select","Select",""],["","00143962125","CYANOCOBALAM","1000MCG","1","Select","Select",""],["","29033000301","SUCRALFATE","1GM","120","Select","Select",""],["","64380071206","BENZONATATE","100MG","15","Select","Select",""],["","50383008716","GUAIATUSS","100-10\/5","120","Select","Select",""],["","00591352530","LIDOCAINE","5%","-30","Select","Select",""],["","50228018005","GABAPENTIN","300MG","90","Select","Select",""],["","70010077001","METHOCARBAM","750MG","30","Select","Select",""],["","59762444002","METHYLPRED","4MG","21","Select","Select",""],["","65162046510","IBUPROFEN","600MG","90","Select","Select",""],["","68462040601","INDOMETHACIN","25MG","21","Select","Select",""],["","31722071390","PANTOPRAZOLE","40MG","30","Select","Select",""],["","59746017506","PREDNISONE","20MG","21","Select","Select",""],["","64380074206","BUSPIRONE ","10MG","-90","Select","Select",""],["","65862052890","VENLAFAXINE ","75MG ER","-30","Select","Select",""],["","50111078710","AZITHROMYCIN ","250MG","-6","Select","Select",""],["","00185111160","BUPROPION ","200MG SR","60","Select","Select",""],["","59762444002","METHYLPRED ","4MG","21","Select","Select",""],["","70010077001","METHOCARBAM ","750MG","90","Select","Select",""],["","31722094101","HYDROCO\/APAP ","5-325MG","30","Select","Select",""],["","00591352530","LIDOCAINE ","5%","30","Select","Select",""],["","00591292754","LEVALBUTEROL ","45\/ACT","15","Select","Select",""],["","59746021106","CYCLOBENZAPR ","5MG","30","Select","Select",""],["","00143962125","CYANOCOBALAM ","1000MCG","-1","Select","Select",""],["","29300022019","MONTELUKAST ","10MG","30","Select","Select",""],["","64380071206","BENZONATATE ","100MG","15","Select","Select",""],["","59746017506","PREDNISONE ","20MG","21","Select","Select",""],["","68462040601","INDOMETHACIN ","25MG","21","Select","Select",""],["","50228018005","GABAPENTIN ","300MG","90","Select","Select",""],["","65162083366","DICLOFENAC ","1%","100","Select","Select",""],["","31722071390","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","29033000301","SUCRALFATE ","1GM","120","Select","Select",""],["","50383008716","GUAIATUSS ","100-10\/5","120","Select","Select",""],["","65162046510","IBUPROFEN ","600MG","90","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","59267100002","PFIZER ","INJ COVID-19","0","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","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","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":""}]}]}