{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAMES   MARTIN OHLSTEIN","gend":0,"add":"1849 EDEN WAY","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1959-07-21","age":"","mstatus":"","insh":"1443424*02","cliId":"","pno":"757\/650-9899","cno":"757\/650-9899","email":"","ename":"","eno":"","pphy":"WOODARD, ROBERT M 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":"ACA","lob":"Individual","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":["Z12.11","F43.24","E11.9","C61.","G25.0","Z01.810","Z01.818","R25.1","I70.90","D68.51","E78.5","F31.9","I10.","Z91.048","Z79.01","Z86.711","Z86.718","Z95.828","Z87.891","Z79.899","R22.0","Z96.9","D68.2","E66.01","E78.00","Z85.46","H04.123","H35.363","H35.82","H40.013","H25.13","M10.9"],"date":["2021-05-23","2021-01-20","2021-09-06","2021-09-07","2021-09-30","2021-06-24","2021-07-14","2021-07-16","2021-07-14","2021-07-22","2021-09-06","2021-07-22","2021-07-15","2021-07-15","2021-07-22","2021-07-22","2021-07-22","2021-07-15","2021-07-22","2021-07-22","2021-07-16","2021-07-16","2021-03-24","2021-03-24","2021-07-22","2021-03-18","2020-12-10","2020-12-10","2020-12-10","2020-12-10","2020-12-10","2021-09-06"],"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":[["","13668001105","CITALOPRAM","40MG","90","Select","Select",""],["","62756079888","DIVALPROEX","500MG DR","-180","Select","Select",""],["","68180098103","LISINOPRIL ","20MG","90","Select","Select",""],["","62756079888","DIVALPROEX ","500MG DR","270","Select","Select",""],["","00115166003","PROPRANOLOL ","20MG","60","Select","Select",""],["","70377002811","ATORVASTATIN ","20MG","30","Select","Select",""],["","31722070530","VALACYCLOVIR ","1GM","14","Select","Select",""],["","50458058030","XARELTO ","10MG","90","Select","Select",""],["","13668001105","CITALOPRAM ","40MG","30","Select","Select",""],["","00169413212","OZEMPIC ","2\/1.5ML","-9","Select","Select",""],["","51862085601","CARB\/LEVO ","25-100MG","270","Select","Select",""],["","00406012405","HYDROCO\/APAP ","7.5-325","30","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","55111032101","GLIMEPIRIDE ","2MG","90","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","12","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","70377002811","ATORVASTATIN","20MG","30","Select","Select",""],["","50458058030","XARELTO","10MG","30","Select","Select",""],["","31722070530","VALACYCLOVIR","1GM","-14","Select","Select",""],["","00115166003","PROPRANOLOL","20MG","60","Select","Select",""],["","55111032101","GLIMEPIRIDE","2MG","90","Select","Select",""],["","68180098003","LISINOPRIL","10MG","90","Select","Select",""],["","00169413212","OZEMPIC","2\/1.5ML","-2","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","51862085601","CARB\/LEVO","25-100MG","270","Select","Select",""],["","00406012405","HYDROCO\/APAP","7.5-325","30","Select","Select",""],["","69547035302","NARCAN","","-2","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","9","Select","Select",""],["","19515081852","FLULAVAL","2021-22","0","Select","Select",""],["","00378064110","PREDNISONE","10MG","18","Select","Select",""],["","59267100003","PFIZER","COVID-19","0","Select","Select",""],["","19515081852","FLULAVAL ","INJ 2021-22","0","Select","Select",""],["","59267100003","PFIZER ","INJ COVID-19","0","Select","Select",""],["","00378064110","PREDNISONE ","TAB 10MG","18","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}