{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TAMIKA   B JACKSON","gend":1,"add":"1134 9TH ST APT A","city":"ALTAVISTA","state":"VA","zip":"24517-9998","dob":"1990-01-18","age":"","mstatus":"","insh":"1428899*01","cliId":"","pno":"434\/616-0109","cno":"","email":"","ename":"","eno":"","pphy":"RAFFERTY, MOIRA MD","ppno":"434\/534-6868","pcpadd":"1088 LONDON LINKS RD","pcpcity":"FOREST","pcpstate":"VA","pcpzip":24551,"pcpcounty":"","pcpid":"","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/534-8808","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z20.828","Z11.59","A08.4","I10.","R53.1","K08.89","K05.5","F31.76","F17.210","Z91.19","Z76.89","G43.909","Z71.82","E66.01","R00.2","R53.83","Z13.220","Z13.228","Z11.4","G47.01","F31.9","Z71.3","F41.8","S86.819A","R42.","Z71.6","Z87.898","J34.89","H66.001","S83.92XA","S46.912A","R55.","W18.30XA","R52.","R40.4","R03.0","H81.10","R05.","G44.89","W19.XXXA","L03.113","K02.9","R51.9","J01.90","J45.909","G50.1"],"date":["2020-08-25","2020-09-01","2021-03-27","2021-12-05","2021-08-07","2021-08-07","2020-03-28","2021-06-24","2021-08-06","2021-08-06","2020-04-01","2020-04-01","2020-04-08","2020-04-01","2020-04-01","2020-04-01","2020-04-01","2020-04-01","2020-04-01","2020-05-06","2021-11-12","2020-04-08","2020-04-08","2020-04-08","2020-10-23","2020-05-06","2020-04-08","2020-09-01","2021-12-05","2020-10-23","2020-10-23","2020-10-23","2020-10-23","2021-08-06","2021-08-06","2020-03-28","2020-05-06","2020-05-06","2020-10-23","2020-10-23","2021-06-05","2021-08-07","2021-08-07","2021-11-12","2021-11-12","2021-11-17"],"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":[["","","VITAMIN"," VITAMIN ","4","Select","Select",""],["","","HYDROCHLOROT","TAB 25MG","","Select","Select",""],["","","AMOXICILLIN","CAP 500MG","","Select","Select",""],["","","LIDOCAINE","SOL 2% VISC","","Select","Select",""],["","","CHLORTHALID","TAB 25MG","","Select","Select",""],["","","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","","TRAZODONE","TAB 50MG","","Select","Select",""],["","","COUGH\/CHEST","LIQ 20-400","","Select","Select",""],["","","PREDNISONE","PAK 10MG","","Select","Select",""],["","","CLINDAMYCIN","CAP 300MG","","Select","Select",""],["","","METHYLPRED","TAB 4MG","","Select","Select",""],["","","LOSARTAN","TAB 25MG","","Select","Select",""],["","","NICOTINE","DIS 21MG\/24H","","Select","Select",""],["","","CVS","DIS 21MG\/24H","","Select","Select",""],["","","ACETAMINOPHN","TAB 500MG","","Select","Select",""],["","","ARIPIPRAZOLE","TAB 5MG","","Select","Select",""],["","","AMLODIPINE","TAB 10MG","","Select","Select",""],["","","BENZONATATE","CAP 100MG","","Select","Select",""],["","","FLUCONAZOLE","TAB 150MG","","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":""}]}]}