{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANDREW CALHOUN JR","gend":0,"add":"528 CORAPEAKE DR","city":"CHESAPEAKE","state":"VA","zip":"23322-9998","dob":"1968-11-28","age":"","mstatus":"","insh":"20049611*01","cliId":"","pno":"757\/509-0303","cno":"757\/509-0649","email":"","ename":"","eno":"","pphy":"HENDRICK, STEPHANIE H NP","ppno":"757\/436-1234","pcpadd":"108 KNELLS RIDGE BLVD STE 100","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":"","pcpname":"Privia - Atwood Family Medical Center","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/548-3665","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.4","F43.12","F31.32","F31.9","C92.Z0","F51.05","N30.01","F31.13","F31.74","F91.8","J10.1","R50.9","K75.81","R94.5","K85.90","R10.9","C95.90","F31.12","F31.64","C92.10","K76.0","E80.4","V62.84","K86.1","Z62.810","E55.9","K76.89","Z85.6","Z90.49","Z87.19","J90.","F32.9","Z87.891","Z79.899","F31.60","Z63.79","Z23.","F41.1","Z00.00","Z13.0","Z13.220","Z13.29","Z13.228","Z12.5","Z68.29","R41.82","Z01.810","F31.73","F31.71","R10.13","K85.30","T45.1X5A","Z87.442","Z12.11","Z51.81","F31.30","Z20.822","R53.83","R74.0","E80.6","E80.7","Z86.59","K85.10","E86.0","K80.20","D72.828","E61.1","F10.99","Z85.528","C95.00","R16.1","R11.0","Z65.0"],"date":["2020-10-06","2020-10-06","2020-10-06","2021-08-25","2021-01-20","2021-02-22","2021-04-04","2021-07-28","2021-07-28","2021-07-28","2020-01-28","2020-01-28","2020-04-06","2020-04-06","2021-11-09","2021-11-05","2021-01-17","2021-01-20","2021-01-25","2021-11-30","2021-11-05","2021-01-16","2021-01-16","2021-01-16","2021-01-16","2021-01-16","2021-11-05","2021-11-05","2021-11-05","2021-11-05","2021-11-05","2021-11-05","2021-11-05","2021-11-05","2021-01-17","2021-01-20","2021-11-30","2021-08-25","2020-12-02","2020-12-02","2020-12-02","2020-12-02","2020-12-02","2020-12-02","2020-12-02","2021-01-16","2021-02-11","2021-04-07","2021-06-01","2020-04-17","2020-05-14","2020-05-14","2020-05-14","2020-06-18","2020-10-30","2021-01-16","2021-01-16","2021-01-17","2019-12-18","2019-04-11","2019-04-10","2019-04-10","2019-04-06","2019-04-06","2019-04-10","2019-05-01","2019-05-01","2019-04-07","2019-04-09","2019-04-08","2019-04-08","2019-04-08","2021-08-25"],"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":[["","","SPRYCEL","TAB 100MG","","Select","Select",""],["","","LITHIUM","TAB 300MG","","Select","Select",""],["","68382011414","RISPERIDONE","TAB 1MG","30","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","43598065530","BUPROPN","TAB 150MG XL","90","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","30","Select","Select",""],["","69315090501","LORAZEPAM","TAB 1MG","90","Select","Select",""],["","","OXYCODONE","TAB 5MG","","Select","Select",""],["","00904530760","BANOPHEN","CAP 50MG","30","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","67877025145","TRIAMCINOLON","CRE 0.001","454","Select","Select",""],["","00078059287","TASIGNA","CAP 150MG","112","Select","Select",""],["","","OSELTAMIVIR","CAP 75MG","","Select","Select",""],["","","BENZONATATE","CAP 100MG","","Select","Select",""],["","","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","","QUETIAPINE","TAB 50MG","","Select","Select",""],["","","DICYCLOMINE","TAB 20MG","","Select","Select",""],["","","LAMOTRIGINE","TAB 25MG","","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":""}]}]}