{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CAROLINE   ANNE PETRULIS","gend":1,"add":"905 POQUOSON CIR","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1961-07-10","age":"","mstatus":"","insh":"4124928*01","cliId":"","pno":"757\/463-9754","cno":"757\/463-9754","email":"","ename":"","eno":"","pphy":"TENNANT, BRADLEY 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":["E78.00","K21.00","F32.9","E55.9","K76.89","K80.20","K82.8","R10.13","R19.4","K57.30","K31.89","H34.8310","H40.041","H25.11","H25.12","H18.451","H18.452","K80.12","Z23.","H40.013","H34.231","K80.10","K81.9","K59.09","R07.89","F41.9","K50.90","Z12.11","Z11.52","Z79.899","Z88.5","Z88.2","Z88.1","Z91.040","K21.9","D53.9","Z90.710","Z83.79","Z90.49","S05.01XA"],"date":["2021-04-27","2020-10-20","2021-04-12","2021-04-27","2020-10-30","2021-01-26","2020-10-30","2020-11-24","2020-11-24","2020-11-24","2020-11-24","2021-11-22","2021-11-22","2021-10-15","2021-10-15","2021-10-15","2021-08-06","2021-01-26","2021-04-13","2020-07-06","2020-07-06","2021-01-26","2021-01-26","2020-10-19","2020-04-17","2021-04-12","2020-04-17","2020-08-31","2021-01-22","2021-01-26","2021-01-26","2021-01-26","2021-01-26","2021-01-26","2021-01-26","2021-01-26","2021-01-26","2021-01-26","2021-01-26","2021-11-07"],"priorHcc":["","","","","","","","","","","",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":[["","69452015120","VITAMIN","50000UNT","4","Select","Select",""],["","68180035202","SERTRALINE","50MG","45","Select","Select",""],["","43598050930","ESOMEPRA","20MG DR","30","Select","Select",""],["","00172392670","DIAZEPAM","5MG","30","Select","Select",""],["","00406012301","HYDROCO\/APAP","5-325MG","15","Select","Select",""],["","58160088552","FLUARIX","2020-21","0","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","4","Select","Select",""],["","68180035202","SERTRALINE ","50MG","45","Select","Select",""],["","00172392670","DIAZEPAM ","5MG","30","Select","Select",""],["","43598050930","ESOMEPRA ","20MG DR","30","Select","Select",""],["","00406012301","HYDROCO\/APAP ","5-325MG","15","Select","Select",""],["","58160088552","FLUARIX ","2020-21","0","Select","Select",""],["","70436001006","BUPROPN","150MG XL","90","Select","Select",""],["","68180044601","QUETIAPINE","50MG","90","Select","Select",""],["","70436001006","BUPROPN ","TAB 150MG XL","90","Select","Select",""],["","68180044601","QUETIAPINE ","TAB 50MG","90","Select","Select",""],["","00574402435","ERYTHROMYCIN ","OIN 5MG\/GM","4","Select","Select",""],["","59267100002","PFIZER ","INJ 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":""}]}]}