{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"THOMAS JARRETT III","gend":0,"add":"100 45TH ST","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1960-08-25","age":"","mstatus":"","insh":"2056912*01","cliId":"","pno":"757\/287-3525","cno":"757\/287-3525","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":["Z08.","Z85.828","D22.5","L82.1","N40.1","N13.8","Z80.42","Z00.00","Z12.11","B00.9","Z20.828","H04.123","H35.362","H11.001","H11.002","M77.11","M25.521","G89.29","L81.2","L57.0","R79.89","E04.1","I48.0","E89.0","Z12.5","L30.0","L90.5","L70.5"],"date":["2021-09-10","2021-09-10","2020-02-04","2021-02-12","2020-09-04","2020-09-04","2020-09-04","2021-09-14","2021-08-30","2020-10-30","2020-10-30","2021-02-16","2021-02-16","2021-02-16","2021-02-16","2021-02-19","2021-02-19","2021-02-19","2020-10-13","2021-09-10","2020-10-27","2021-10-29","2021-10-29","2021-10-29","2021-10-29","2021-02-12","2021-09-10","2021-09-10"],"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":[["","57237001401","TAMSULOSIN","0.4MG","90","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","31722070430","VALACYCLOVIR","500MG","90","Select","Select",""],["","00378180710","LEVOTHYROXIN","88MCG","100","Select","Select",""],["","70461032003","FLUCLVX","2020-21","0","Select","Select",""],["","51672127401","BETAMETH","0.05%","30","Select","Select",""],["","57237001401","TAMSULOSIN ","0.4MG","90","Select","Select",""],["","31722070430","VALACYCLOVIR ","500MG","90","Select","Select",""],["","00378180710","LEVOTHYROXIN ","88MCG","100","Select","Select",""],["","68180016013","AZITHROMYCIN ","250MG","6","Select","Select",""],["","70461032003","FLUCLVX ","2020-21","0","Select","Select",""],["","51672127401","BETAMETH ","0.05%","30","Select","Select",""],["","65649040001","PLENVU","","3","Select","Select",""],["","62756023290","LOTEPREDNOL","0.50%","5","Select","Select",""],["","62756023290","LOTEPREDNOL ","SUS 0.005","5","Select","Select",""],["","80777027398","MODERNA ","INJ COVID-19","0","Select","Select",""],["","65649040001","PLENVU ","SOL ","3","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":""}]}]}