{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANDREW   W VAKOS","gend":0,"add":"177 PINEWOOD ROAD","city":"VIRGINIA BEACH","state":"VA","zip":"23451-9998","dob":"1965-01-22","age":"","mstatus":"","insh":"2054166*01","cliId":"","pno":"757\/428-8786","cno":"757\/428-8786","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":"757\/438-2820","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":["Z94.0","I10.","N02.8","E66.3","R19.7","I12.0","N18.5","K71.6","T50.905A","N25.81","Z12.5","Z20.828","E78.5","B34.9","J32.0","J34.89","R05.9","Q61.9","Z79.52","Z87.448","N26.1","N18.6","T82.9XXA"],"date":["2021-11-08","2021-09-15","2021-09-15","2021-04-28","2020-02-06","2020-10-20","2020-10-20","2020-09-09","2020-09-09","2020-09-09","2020-09-09","2021-02-04","2021-09-15","2021-02-04","2021-10-28","2021-10-28","2021-10-28","2021-11-08","2021-11-08","2021-11-08","2021-11-08","2021-10-29","2021-10-29"],"priorHcc":[null,"","","","","","","","","","","","","",null,null,null,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":[["","00054474225","PREDNISONE","2.5MG","30","Select","Select",""],["","00781210301","TACROLIMUS","1MG","150","Select","Select",""],["","31722088530","ROSUVASTATIN","40MG","30","Select","Select",""],["","60505296507","MYCOPHENOLIC","180MG DR","-240","Select","Select",""],["","00781577626","AZITHROMYCIN","250MG","6","Select","Select",""],["","68382009405","CARVEDILOL","12.5MG","60","Select","Select",""],["","99073070914","FREESTYLE KIT FREEDOM","FREEDOM","1","Select","Select",""],["","99073070822","FREESTYLE TES LITE","LITE","50","Select","Select",""],["","99073013001","FREESTYLE MIS LANCETS","LANCETS","100","Select","Select",""],["","62135098505","DOXYCYCL","100MG","20","Select","Select",""],["","31722088530","ROSUVASTATIN ","40MG","30","Select","Select",""],["","68382009405","CARVEDILOL ","12.5MG","60","Select","Select",""],["","00054474225","PREDNISONE ","2.5MG","30","Select","Select",""],["","00781577626","AZITHROMYCIN ","250MG","6","Select","Select",""],["","60505296507","MYCOPHENOLIC ","180MG DR","-240","Select","Select",""],["","00781210301","TACROLIMUS ","1MG","-150","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","LANCETS","100","Select","Select",""],["","99073070822","FREESTYLE    TES LITE","LITE","50","Select","Select",""],["","99073070914","FREESTYLE    KIT FREEDOM","FREEDOM","1","Select","Select",""],["","62135098505","DOXYCYCL ","100MG","20","Select","Select",""],["","59267100003","PFIZER ","COVID-19","0","Select","Select",""],["","59267100003","PFIZER","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","",""],["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":""}]}]}