{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SAYED   HASSAN HASSAN","gend":0,"add":"2027 ELM TREE CT","city":"CHARLOTTESVILLE","state":"VA","zip":"22911-9998","dob":"1979-04-02","age":"","mstatus":"","insh":"2243282*01","cliId":"","pno":"434\/409-9257","cno":"434\/409-9257","email":"","ename":"","eno":"","pphy":"DONOVAN, DEIRDRE E MD","ppno":"434\/817-1818","pcpadd":"STE 9 310 AVON STREET","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22902,"pcpcounty":"","pcpid":210490,"pcpname":"Privia - Downtown Family Health Care, Inc","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/817-9606","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L73.9","M79.632","M25.521","I10.","M25.562","F43.10","R39.11","H93.8X2","G89.29","N53.8","N48.30","K76.89","Z23.","M77.11","R12.","L70.0","M54.5","F33.1","N20.1","Z98.890","NO DATA","R10.11","K76.9","N20.0","M77.01","F33.2","R10.9","R68.82","Q55.61","N48.89","M54.89","R07.89","M54.6","Z87.442","N99.114","R21.","Z46.6","N39.0","Z03.818","Z20.828","K21.9","Z71.6","Z79.899","R13.10","R10.13"],"date":["2020-09-04","2020-02-14","2020-10-06","2021-03-11","2021-03-25","2020-09-24","2020-01-24","2020-01-24","2021-03-25","2020-04-29","2020-08-24","2021-07-21","2021-04-07","2020-10-06","2020-02-14","2020-09-04","2020-03-09","2020-09-24","2020-08-10","2020-08-10","2021-11-05","2021-11-05","2021-07-21","2020-07-07","2020-08-04","2020-09-10","2020-06-18","2020-10-28","2020-10-28","2020-12-02","2021-02-17","2021-02-17","2021-03-25","2021-04-13","2020-04-09","2020-05-11","2020-06-25","2020-03-29","2020-12-13","2020-12-13","2020-10-14","2020-10-14","2020-10-14","2021-11-05","2021-10-20"],"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":[["","00093314705","CEPHALEXIN ","500MG","28","Select","Select",""],["","68180098003","LISINOPRIL ","10MG","30","Select","Select",""],["","00406055201","OXYCODONE ","5MG","20","Select","Select",""],["","68180035202","SERTRALINE ","50MG","30","Select","Select",""],["","13107003105","MIRTAZAPINE ","15MG","30","Select","Select",""],["","64380080308","RANITIDINE ","150MG","60","Select","Select",""],["","00781709459","ERY\/BENZOYL ","5-3%","47","Select","Select",""],["","57237001405","TAMSULOSIN ","0.4MG","30","Select","Select",""],["","50383077504","LIDOCAINE ","2% VISC","100","Select","Select",""],["","0","","","85","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","30","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","28","Select","Select",""],["","68462019005","NAPROXEN ","500MG","30","Select","Select",""],["","69097052444","DICLOFENAC ","1%","100","Select","Select",""],["","00713028031","BACITRACIN ","500\/GM","28","Select","Select",""],["","00603497528","OXYBUTYNIN ","5MG","20","Select","Select",""],["","55111012705","CIPROFLOXACN ","500MG","28","Select","Select",""],["","00904645780","DOK ","100MG","30","Select","Select",""],["","50111064803","FLUOXETINE ","20MG","30","Select","Select",""],["","45802004064","SELENIUM ","2.50%","120","Select","Select",""],["","00143211205","DOXYCYCL ","100MG","90","Select","Select",""],["","00067815202","VOLTAREN ","1%","100","Select","Select",""],["","51293081101","PHENAZOPYRID ","200MG","9","Select","Select",""],["","51991074710","DULOXETINE ","30MG","60","Select","Select",""],["","00093406801","PRAZOSIN ","2MG","30","Select","Select",""],["","00093585105","ESCITALOPRAM ","10MG","30","Select","Select",""],["","00093738456","VENLAFAXINE ","37.5 ER","30","Select","Select",""],["","62332000191","FAMOTIDINE ","20MG","180","Select","Select",""],["","00591040710","LISINOPRIL","10MG","30","Select","Select",""],["","65162019050","NAPROXEN","500MG","30","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","28","Select","Select",""],["","68180035202","SERTRALINE","50MG","30","Select","Select",""],["","13107003105","MIRTAZAPINE","15MG","30","Select","Select",""],["","57237001405","TAMSULOSIN","0.4MG","30","Select","Select",""],["","64380080308","RANITIDINE","150MG","60","Select","Select",""],["","00781709459","ERY\/BENZOYL","5-3%","47","Select","Select",""],["","00713028031","BACITRACIN","500\/GM","28","Select","Select",""],["","00406055201","OXYCODONE","5MG","20","Select","Select",""],["","00904645780","DOK","100MG","30","Select","Select",""],["","50383077504","LIDOCAINE","2% VISC","100","Select","Select",""],["","55111012705","CIPROFLOXACN","500MG","28","Select","Select",""],["","00603497528","OXYBUTYNIN","5MG","20","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","28","Select","Select",""],["","67877032005","IBUPROFEN","600MG","15","Select","Select",""],["","65162083366","DICLOFENAC","1%","100","Select","Select",""],["","45802004064","SELENIUM","2.50%","118","Select","Select",""],["","00143211205","DOXYCYCL","100MG","90","Select","Select",""],["","00093719805","FLUOXETINE","40MG","30","Select","Select",""],["","51293081101","PHENAZOPYRID","200MG","9","Select","Select",""],["","51991074710","DULOXETINE","30MG","60","Select","Select",""],["","00067815202","VOLTAREN","1%","100","Select","Select",""],["","00093738456","VENLAFAXINE","37.5 ER","30","Select","Select",""],["","00093406801","PRAZOSIN","2MG","30","Select","Select",""],["","00093585105","ESCITALOPRAM","10MG","30","Select","Select",""],["","62332000191","FAMOTIDINE","20MG","180","Select","Select",""],["","55111015810","OMEPRAZOLE ","CAP 20MG","30","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","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}