{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARY   E BEEBE","gend":1,"add":"1437 PRESERVE DR VIRGINIA BEACH VIRGINIA (VA)","city":"VIRGINIA BEACH","state":"VA","zip":"23451-9998","dob":"1961-02-26","age":"","mstatus":"","insh":"1777723*01","cliId":"","pno":"757\/237-3360","cno":"757\/237-3360","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":"Small Group","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":["C50.411","Z17.0","C50.911","D05.11","J01.00","H10.89","B02.9","H16.141","N20.0","Z00.00","E55.9","M25.50","F33.9","Z98.890","R68.89","H57.11","B02.33","M31.6","N64.4","Z12.31","N64.89","K21.9","R10.13","U07.1","R05.","J20.9","J01.90","N60.81","N60.11","N62.","R07.9","B02.29","N63.10","L91.9","N63.11","Z87.891","Z85.3","N63.15","L91.8","Z23.","Z12.11","Z80.0","Z86.010","K63.5","Z71.89","Z88.0","Z88.1","H10.33","J34.89","Z86.19","H92.01","Z80.3","Z90.11","J20.8","Z87.442","R53.81","R92.2","Z20.828","R53.83","N39.0"],"date":["2020-11-11","2020-11-11","2021-04-27","2020-05-13","2020-11-09","2020-11-09","2021-05-18","2020-11-13","2020-12-07","2021-05-18","2021-05-11","2021-05-18","2021-05-11","2021-08-25","2020-04-24","2020-11-25","2020-11-25","2020-11-25","2021-08-25","2020-02-12","2021-02-04","2020-06-18","2020-06-18","2020-08-06","2020-07-27","2020-08-06","2020-01-16","2020-02-24","2020-02-24","2020-02-24","2020-08-06","2020-12-21","2021-03-05","2021-03-05","2020-02-24","2020-11-11","2021-08-25","2021-03-05","2021-03-05","2021-04-07","2020-01-07","2020-01-07","2020-01-07","2020-01-07","2020-07-27","2020-11-11","2020-11-11","2020-09-22","2020-11-11","2020-11-11","2020-11-11","2020-03-10","2021-02-04","2020-08-06","2020-08-06","2020-08-06","2021-02-04","2021-08-27","2021-08-25","2021-08-25"],"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":[["","67877057505","BENZONATATE ","200MG","30","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","20","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","30","Select","Select",""],["","16729003415","LETROZOLE ","2.5MG","90","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","56","Select","Select",""],["","13107008405","LORAZEPAM ","1MG","2","Select","Select",""],["","50111064701","FLUOXETINE ","10MG","90","Select","Select",""],["","59651000305","OMEPRAZOLE ","40MG","90","Select","Select",""],["","69097014260","ALBUTEROL ","HFA","7","Select","Select",""],["","59762305102","AZITHROMYCIN ","1GM PAK","3","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","24208091055","ERYTHROMYCIN ","OP","4","Select","Select",""],["","58160088552","FLUARIX ","2020-21","0","Select","Select",""],["","50580054548","SUDAFED ","30MG","30","Select","Select",""],["","61314062810","POLYMYXIN ","TRIMETHP","10","Select","Select",""],["","00378064205","PREDNISONE ","20MG","15","Select","Select",""],["","23155022801","ACYCLOVIR ","800MG","50","Select","Select",""],["","69097094312","GABAPENTIN ","300MG","60","Select","Select",""],["","08373747800","OPTICHAMBER ","DIAMOND","1","Select","Select",""],["","31722070530","VALACYCLOVIR ","1GM","21","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","00173056504","VALTREX ","1GM","21","Select","Select",""],["","67877057505","BENZONATATE","200MG","30","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","50111064701","FLUOXETINE","10MG","90","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","30","Select","Select",""],["","16729003415","LETROZOLE","2.5MG","90","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","56","Select","Select",""],["","13107008405","LORAZEPAM","1MG","2","Select","Select",""],["","59651000305","OMEPRAZOLE","40MG","90","Select","Select",""],["","59762305102","AZITHROMYCIN","1GM PAK","1","Select","Select",""],["","69097014260","ALBUTEROL","HFA","7","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","08373747800","OPTICHAMBER","DIAMOND","1","Select","Select",""],["","58160088552","FLUARIX","2020-21","0","Select","Select",""],["","24208091055","ERYTHROMYCIN","OP","4","Select","Select",""],["","61314062810","POLYMYXIN","TRIMETHP","10","Select","Select",""],["","50580054548","SUDAFED","30MG","30","Select","Select",""],["","00378064205","PREDNISONE","20MG","15","Select","Select",""],["","23155022801","ACYCLOVIR","800MG","50","Select","Select",""],["","31722070530","VALACYCLOVIR","1GM","21","Select","Select",""],["","69097094312","GABAPENTIN","300MG","60","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","00173056504","VALTREX","1GM","21","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":""}]}]}