{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROSA MATIAS","gend":1,"add":"PO BOX 403","city":"ONANCOCK","state":"VA","zip":"23417-9998","dob":"1959-01-03","age":"","mstatus":"","insh":"20031663*01","cliId":"","pno":"757\/387-9360","cno":"","email":"","ename":"","eno":"","pphy":"STILES, MARGARET MD","ppno":"757\/787-7374","pcpadd":"20306 BADGER LN","pcpcity":"ONLEY","pcpstate":"VA","pcpzip":23418,"pcpcounty":"","pcpid":"","pcpname":"Privia - Churchland Family Medicine, P.C.","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/787-4513","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I21.11","I21.3","I25.10","Z95.5","R07.9","I25.118","R06.02","R00.0","R94.31","G40.909","J98.01","J45.909","Z20.822","J45.901","Z20.828","J45.21","R06.2","R06.4","I21.4","I20.0","I25.119","J45.50","I10.","M89.49","R73.03","Z71.3","R07.89","F41.9","M19.90","Z79.899","R56.9","E78.5","T82.855A","E11.9","Z88.6","Z79.51","I25.2","I25.110","J45.30","E53.8","G62.9","K21.9","E66.9","F41.8","Z87.898","I08.0","Z91.14","R41.82","K62.5","K57.90","K76.0","J45.41","R11.2","R19.7","R10.11","M54.6","R10.84","Z12.4","T78.2XXA","R10.13","R55.","K64.9","E78.00","Z86.2","M81.0","E66.09","Z68.36","J45.51","T88.6XXA","J96.00","T45.0X5A","Z88.8","K21.0","G40.409","R03.0"],"date":["2020-11-18","2020-11-18","2021-12-17","2021-12-17","2021-12-17","2021-12-17","2021-12-17","2021-12-18","2021-12-18","2021-12-17","2021-12-17","2021-12-17","2021-12-17","2021-09-03","2020-10-07","2020-09-08","2020-09-08","2020-09-08","2020-10-08","2020-10-07","2021-11-19","2021-10-27","2021-11-19","2021-08-31","2021-08-31","2021-08-31","2021-03-30","2021-03-30","2021-09-03","2021-09-03","2021-12-23","2020-11-18","2020-11-18","2020-11-18","2020-11-18","2020-11-18","2021-12-17","2020-10-07","2020-10-07","2020-10-07","2020-10-07","2020-10-07","2020-10-07","2020-10-07","2020-10-07","2020-10-08","2021-12-17","2021-12-17","2020-10-30","2020-10-30","2020-10-30","2020-03-10","2020-03-10","2020-03-10","2021-10-27","2021-10-27","2019-05-15","2019-05-15","2019-05-16","2019-05-20","2019-05-20","2019-05-15","2019-07-12","2019-07-12","2019-07-12","2019-07-12","2019-07-12","2019-01-23","2019-05-15","2019-05-15","2019-05-15","2019-05-15","2019-05-15","2019-07-02","2019-10-17"],"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":[["","","BUDES\/FORMOT","AER 160-4.5","","Select","Select",""],["","72205000490","ROSUVASTATIN","TAB 20MG","30","Select","Select",""],["","29300022019","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","50742061701","METOPROL","TAB 100MG ER","30","Select","Select",""],["","00487020103","IPRATROPIUM\/","SOL ALBUTER","180","Select","Select",""],["","","BRILINTA","TAB 90MG","","Select","Select",""],["","59310057922","PROAIR","AER ","17","Select","Select",""],["","","COMBIVENT","AER 20-100","","Select","Select",""],["","","LISINOPRIL","TAB 2.5MG","","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","00143973805","PREDNISONE","TAB 20MG","14","Select","Select",""],["","","NITROGLYCERN","SUB 0.4MG","","Select","Select",""],["","00085113204","PROVENTIL","AER HFA","7","Select","Select",""],["","08373245600","NEBULIZER","KIT SAMI","1","Select","Select",""],["","65862024608","LEVETIRACETA","TAB 500MG","120","Select","Select",""],["","50268086615","VITAMIN","TAB 5000UNIT","30","Select","Select",""],["","","CARVEDILOL","TAB 3.125MG","","Select","Select",""],["","69097022416","ALENDRONATE","TAB 70MG","4","Select","Select",""],["","","AMOX\/K","TAB 875-125","","Select","Select",""],["","","PROMETHAZINE","TAB 25MG","","Select","Select",""],["","","PRASUGREL","TAB 10MG","","Select","Select",""],["","00597008717","ATROVENT","AER 17MCG","39","Select","Select",""],["","55111015930","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","00536116134","MUCUS","TAB 30-600ER","20","Select","Select",""],["","68645014059","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","49035048462","ACETAMINOPHN","TAB 500MG","30","Select","Select",""],["","10939053644","CALCIUM\/D","TAB 600-800","60","Select","Select",""],["","68645049554","ATORVASTATIN","TAB 80MG","30","Select","Select",""],["","59741030124","HYDROCORT","SUP 25MG","12","Select","Select",""],["","55111015330","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","00713050324","ANUCORT-HC","SUP 25MG","12","Select","Select",""],["","00904672080","ACETAMIN","TAB 500MG","30","Select","Select",""],["","00005550919","CALTRATE","TAB 600-800","60","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":""}]}]}