{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TAYLOR   L DAVIS","gend":1,"add":"31 LAUREL GATE CIR LOT 33","city":"MARTINSVILLE","state":"VA","zip":"24112-9998","dob":"1999-09-14","age":"","mstatus":"","insh":"8098603*01","cliId":"","pno":"276\/403-2528","cno":"","email":"","ename":"","eno":"","pphy":"MAHONEY, MARK DO","ppno":"434\/544-2315","pcpadd":"650 N LEE HWY","pcpcity":"LEXINGTON","pcpstate":"VA","pcpzip":24450,"pcpcounty":"","pcpid":"","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/338-6313","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O20.0","S62.605A","O23.42","Z3A.18","F33.1","O47.03","Z36.85","Z11.3","Z3A.35","O34.219","Z37.0","Z3A.36","L03.311","R03.0","Z20.828","V23.89","O99.511","J06.9","J03.90","Z3A.00","Z32.01","S03.8XXA","Z32.02","Z34.82","Z36.9","Z3A.20","Z3A.30","R30.0","N39.0","S93.401A","W18.40XA","R07.0","J39.9","Z20.822","Z3A.23","F32.0","F41.9","V23.41","Z87.51","Z23.","R31.9","R31.29","O60.13X0","D62.","O34.211","O90.81","R82.90","Z3A.26","M54.89","S02.2XXA","W22.8XXA","O99.891","Z3A.21","O23.41","R10.31","Z3A.10","Z03.89","J02.9","Z3A.08","Z33.1","Z3A.32","Z98.890","Z34.83","O99.89","R51.","Z3A.13","Z34.81","R82.79","Z3A.17","O90.89","R10.11","Z3A.33","S46.919A","O36.8131","Z3A.37","Z96.22","Z88.0","Z88.7","Z91.048","N91.2","Z72.51","N91.1","R81.","O99.810","Z39.1","O62.0","O33.5XX1","Z38.01","Z3A.39","O23.40","R60.0","O15.2","Z39.2","Z3A.19","O33.9"],"date":["2021-07-01","2020-06-12","2020-06-12","2020-06-12","2021-11-14","2020-10-20","2020-10-13","2020-10-13","2020-10-13","2021-11-18","2020-10-22","2020-10-22","2020-11-24","2020-11-24","2021-10-12","2021-11-24","2020-03-25","2021-06-24","2020-03-25","2020-03-25","2020-05-20","2021-03-04","2021-03-31","2021-11-18","2021-10-08","2021-10-08","2020-09-09","2021-05-06","2021-05-06","2021-07-06","2021-07-06","2021-08-26","2021-08-26","2021-10-12","2021-10-29","2021-11-08","2021-11-08","2021-12-08","2021-12-28","2021-12-08","2021-12-08","2021-12-08","2020-10-22","2020-10-22","2020-10-22","2020-10-22","2020-11-05","2021-11-18","2020-09-10","2021-03-01","2021-03-01","2021-10-12","2021-10-12","2020-04-21","2020-04-21","2020-04-21","2021-06-24","2021-06-24","2021-07-01","2021-12-20","2021-12-28","2021-12-28","2021-12-28","2019-12-09","2019-06-05","2019-06-05","2019-06-17","2019-06-17","2019-06-29","2019-12-12","2019-12-12","2019-10-23","2019-10-23","2019-11-14","2019-11-14","2019-06-05","2019-06-05","2019-06-05","2019-06-05","2019-06-11","2019-06-11","2019-07-15","2019-07-15","2019-07-15","2019-10-30","2019-12-03","2019-12-04","2019-12-04","2019-12-04","2019-12-09","2019-12-09","2019-12-12","2019-12-12","2019-07-15","2019-12-03"],"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":[["","","PRENATE","CAP PIXIE","","Select","Select",""],["","68180016006","AZITHROMYCIN","TAB 250MG","4","Select","Select",""],["","64011030103","MAKENA","INJ 275MG","4","Select","Select",""],["","","NITROFURANTN","CAP 100MG","","Select","Select",""],["","","AMOXICILLIN","CAP 500MG","","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","00536100901","FERROUS","TAB 325MG","90","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","75826011510","PHENAZOPYRID","TAB 200MG","9","Select","Select",""],["","61783000012","FC2","MIS CONDOM","24","Select","Select",""],["","68462041929","HAILEY","TAB 44581","364","Select","Select",""],["","70700016406","LEVONORGESTR","TAB 1.5MG","8","Select","Select",""],["","","LO","TAB 40452","","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","25","Select","Select",""],["","67877031901","IBUPROFEN","TAB 400MG","30","Select","Select",""],["","","MICONAZOLE","KIT COMBO","","Select","Select",""],["","","SMZ\/TMP","TAB 800-160","","Select","Select",""],["","45802048678","DOCUSATE","CAP 100MG","60","Select","Select",""],["","64380080307","RANITIDINE","TAB 150MG","60","Select","Select",""],["","00378020810","FUROSEMIDE","TAB 20MG","5","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":""}]}]}