{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRENDA HUMPHREYS","gend":1,"add":"2532 GEORGES RD","city":"POWHATAN","state":"VA","zip":"23139-9998","dob":"1970-10-29","age":"","mstatus":"","insh":"1244103*01","cliId":"","pno":"804\/598-2602","cno":"","email":"","ename":"","eno":"","pphy":"DODD, JEFFREY MD","ppno":"804\/897-2159","pcpadd":"2891 ANDERSON HWY","pcpcity":"POWHATAN","pcpstate":"VA","pcpzip":23139,"pcpcounty":"","pcpid":"","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/250-5774","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N20.0","N13.30","M79.605","N20.1","E66.01","Z68.41","N28.89","I10.","G47.00","R11.0","G43.909","R10.13","Z01.419","D21.9","K21.9","Z46.6","R10.9","E78.00","E55.9","M79.7","M54.5","L30.9","Z01.812","Z20.822","R31.0","Z87.442","N94.89","N20.9","R73.01","Z12.11","Z12.39","R10.11","R10.31","L23.9","V58.89"],"date":["2021-07-14","2021-07-14","2021-08-11","2020-12-02","2021-05-04","2021-05-04","2021-05-04","2021-07-16","2020-07-28","2020-07-28","2020-07-28","2020-07-28","2020-11-20","2020-11-20","2021-05-04","2021-05-04","2021-05-11","2021-07-16","2021-07-16","2020-06-30","2020-06-30","2020-06-30","2021-04-30","2021-04-30","2020-10-28","2020-10-28","2020-10-29","2021-02-02","2021-07-16","2021-07-16","2021-07-16","2021-01-29","2021-03-31","2019-07-23","2019-03-28"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","","LOSARTAN","TAB 50MG","","Select","Select",""],["","","CIPROFLOXACN","TAB 500MG","","Select","Select",""],["","","NAPROXEN"," NAPROXEN ","20","Select","Select",""],["","67877022310","GABAPENTIN","CAP 300MG","30","Select","Select",""],["","63304069205","CLINDAMYCIN","CAP 150MG","28","Select","Select",""],["","","KETOROLAC","TAB 10MG","","Select","Select",""],["","10702020101","OXYBUTYNIN","TAB 5MG","30","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","30","Select","Select",""],["","","METOPROL","TAB 50MG ER","","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","70461032103","FLUCLVX","INJ 2021-22","0","Select","Select",""],["","","TRIAMCINOLON"," TRIAMCINOLON ","5","Select","Select",""],["","","VALACYCLOVIR"," VALACYCLOVIR ","21","Select","Select",""],["","","CLOTRIMAZOLE"," CLOTRIMAZOLE ","30","Select","Select",""],["","","PREDNISONE"," PREDNISONE ","18","Select","Select",""],["","","DOXYCYCL"," DOXYCYCL ","20","Select","Select",""],["","","TAMSULOSIN","CAP 0.4MG","","Select","Select",""],["","","VITAMIN","CAP 50000UNT","","Select","Select",""],["","","OXYCOD\/APAP","TAB 5-325MG","","Select","Select",""],["","","ESZOPICLONE","TAB 2MG","","Select","Select",""],["","","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","","SMZ\/TMP","TAB 800-160","","Select","Select",""],["","","PHENAZOPYRID","TAB 200MG","","Select","Select",""],["","","OXYCODONE","TAB 5MG","","Select","Select",""],["","","RIZATRIPTAN","TAB 10MG ODT","","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}