{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" MARCELL HARRISON","gend":1,"add":"5115 RADCLIFF CIR","city":"PORTSMOUTH","state":"VA","zip":"23703-9998","dob":"1966-12-10","age":"","mstatus":"","insh":"1714184*01","cliId":"","pno":"757\/305-3372","cno":"757\/305-3372, 757\/305-3372, ","email":"","ename":"","eno":"","pphy":"CRUM, FREDERICK C MD","ppno":"757\/484-7386","pcpadd":"3235 ACADEMY AVE STE 101","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":"23703-9998","pcpcounty":"","pcpid":210323,"pcpname":"Privia - Churchland Family Medicine, P.C.","plan":"OHP - OPTIMA","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","F64.0","B20.","Z11.3","Z11.59","Z00.00","Z13.220","E55.9","M51.36","M21.6X1","M20.11","M20.41","M79.671","M20.12","M21.6X2","M20.42","M79.672","Z23."],"date":["2020-05-14","2021-06-08","2021-06-07","2021-06-07","2020-12-08","2021-06-07","2021-06-07","2020-05-14","2021-04-23","2020-12-22","2020-12-22","2020-12-22","2020-12-22","2020-10-02","2020-10-02","2020-10-02","2020-10-02","2020-12-02"],"priorHcc":["","","","","","","","","","","","","","","","","",""]}},{"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":[["","61958250101","BIKTARVY","","30","Select","Select",""],["","55111017915","TIZANIDINE","2MG","90","Select","Select",""],["","51862033401","ESTRADIOL","2MG","30","Select","Select",""],["","68180072003","AMLODIPINE","5MG","90","Select","Select",""],["","60432012608","MEGESTROL","40MG\/ML","300","Select","Select",""],["","65162062711","TRAMADOL","50MG","9","Select","Select",""],["","70010077001","METHOCARBAM","750MG","90","Select","Select",""],["","10888713502","PROGESTERONE","100MG","-30","Select","Select",""],["","29300012510","MELOXICAM","15MG","20","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","",""],["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":""}]}]}