{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LATRICE BLUE","gend":1,"add":"PO BOX 751","city":"SOUTH HILL","state":"VA","zip":"23970-9998","dob":"1996-12-30","age":"","mstatus":"","insh":"6461999*01","cliId":"","pno":"434\/447-3571","cno":"","email":"","ename":"","eno":"","pphy":"POWERS III, GRAHAM H MD","ppno":"434\/584-2025","pcpadd":"514 W ATLANTIC ST","pcpcity":"SOUTH HILL","pcpstate":"VA","pcpzip":23970,"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":"434\/447-2240","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O28.3","Z3A.33","O34.211","F43.10","O99.344","F32.9","O99.824","O99.214","E66.9","Z37.0","Z3A.39","K92.0","R11.2","Z98.890","O21.0","E86.0","Z3A.09","O99.89","Z3A.25","R11.10","Z33.1","Z11.52","R10.84","K52.9","Z3A.01","O34.219","Z3A.37","O21.8","Z3A.00","S51.812A","X99.1XXA","R68.89","O90.2","K59.00","R10.9","N91.2","R74.8","Z3A.08","O99.334","F17.210","R51.9","F39.","S62.631A","L60.8","R07.9","S16.1XXA","R10.30","Z63.0","Z20.9","O99.810","D57.3","O99.820","O12.12","Z3A.20","O99.322","Z3A.36","Z23.","O99.013","Z3A.35","S00.03XA","S41.112A","Y04.8XXA","M54.2","R07.89","M25.512","R53.1","R20.0","W19.XXXA"],"date":["2019-07-08","2019-07-08","2020-07-30","2019-08-14","2019-08-14","2019-08-14","2019-08-14","2020-07-30","2020-07-30","2020-07-30","2019-08-14","2019-08-20","2021-10-08","2019-08-20","2021-10-11","2021-10-11","2020-01-05","2020-05-12","2020-05-12","2021-10-11","2021-10-11","2021-10-25","2019-07-28","2020-01-02","2020-01-02","2020-07-30","2020-07-30","2021-10-09","2021-10-09","2021-03-21","2021-03-21","2021-10-25","2019-08-20","2019-08-20","2019-08-20","2020-03-06","2021-10-11","2021-10-11","2020-07-30","2020-10-25","2020-10-25","2020-10-25","2020-11-23","2020-11-23","2021-07-01","2021-07-01","2019-04-04","2019-04-04","2019-04-04","2019-04-04","2019-04-04","2019-04-04","2019-04-04","2019-04-04","2019-04-04","2019-07-28","2020-07-15","2020-07-15","2020-07-15","2021-03-21","2021-03-21","2021-03-21","2021-07-01","2021-07-01","2021-07-01","2021-07-01","2021-07-01","2021-07-01"],"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":[]},{"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":[["","","CLINDAMYCIN"," CLINDAMYCIN ","40","Select","Select",""],["","","IBUPROFEN"," IBUPROFEN ","60","Select","Select",""],["","","METRONIDAZOL"," METRONIDAZOL ","4","Select","Select",""],["","","DOCUSATE"," DOCUSATE ","30","Select","Select",""],["","","HYDROCO\/APAP"," HYDROCO\/APAP ","25","Select","Select",""],["","","METOCLOPRAM"," METOCLOPRAM ","120","Select","Select",""],["","","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","","PRENATAL","TAB LOW IRON","","Select","Select",""],["","","ZUPLENZ","MIS 4MG","","Select","Select",""],["","","VITAMIN","TAB 25MG","","Select","Select",""],["","","PRENATABS","TAB ","","Select","Select",""],["","","PROMETHAZINE","TAB 25MG","","Select","Select",""],["","","SLEEP-AID","TAB 25MG","","Select","Select",""],["","","FERROUS","TAB 325MG","","Select","Select",""],["","","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","","PANTOPRAZOLE","TAB 20MG","","Select","Select",""],["","","JUNEL","TAB ","","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":""}]}]}