{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JON  S JACKSON","gend":0,"add":"602 LAURA ST","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"1992-09-03","age":"","mstatus":"","insh":"2352840*01","cliId":"","pno":7577769301,"cno":7577769301,"email":"","ename":"","eno":"","pphy":"ELSASS, JARROD LYNN NP","ppno":7574361234,"pcpadd":"108 KNELLS RIDGE BLVD STE 100,","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":"23320-9998","pcpcounty":"","pcpid":"","pcpname":"Privia - Atwood Family Medical Center","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7575483665,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.5","G25.0","M25.561","F41.1","F11.20","F10.232","F10.20","F10.29","F10.239","A69.20","R41.0","G92.","T50.905A","R53.83","M54.9","S01.01XA","Z20.828","F41.9","F10.21","F10.929","F16.929","R40.4","S62.336A","S90.31XA","M79.671","F16.20","K21.9","S81.812A","F17.210","Z79.899","R41.82","T46.904A","S99.921A","F13.10","G89.21","M25.562","G89.29","F19.10","Z13.30","R44.1","F15.21","F12.20","NO DATA","V54.12"],"date":["2021-09-02","2022-09-16","2021-09-02","2022-05-16","2022-09-23","2022-05-17","2022-10-20","2022-09-23","2022-09-23","2022-09-23","2021-02-06","2021-02-06","2021-02-06","2022-09-17","2022-05-17","2022-07-02","2022-09-23","2023-04-08","2023-04-08","2021-06-15","2021-06-15","2021-06-15","2022-05-16","2022-08-07","2022-08-07","2022-09-10","2023-06-06","2023-06-06","2023-06-06","2023-06-06","2021-02-06","2021-02-06","2022-08-07","2022-09-16","2022-09-16","2021-06-29","2021-06-29","2021-07-01","2021-07-01","2021-06-15","2022-05-16","2022-05-16","2022-05-16","2022-05-16"],"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":[["","29300041301","CYCLOBENZAPR TAB","5MG","30","Select","Select",""],["","16729020216","BUSPIRONE TAB","10MG","120","Select","Select",""],["","65162062711","TRAMADOL HCL TAB","50MG","28","Select","Select",""],["","68382080605","TRAZODONE TAB","100MG","60","Select","Select",""],["","00603548321","PROPRANOLOL TAB","20MG","60","Select","Select",""],["","53746010901","HYDROCO\/APAP TAB","5-325MG","6","Select","Select",""],["","67877024210","QUETIAPINE TAB","25MG","30","Select","Select",""],["","45963055650","GABAPENTIN CAP","300MG","90","Select","Select",""],["","00185067605","HYDROXYZ PAM CAP","50MG","60","Select","Select",""],["","00904053961","THERA TAB","","30","Select","Select",""],["","53746036110","FOLIC ACID TAB","1MG","30","Select","Select",""],["","68462039710","OMEPRAZOLE CAP","40MG","30","Select","Select",""],["","69315090505","LORAZEPAM TAB","1MG","2","Select","Select",""],["","80681008600","MELATONIN TAB","3MG","30","Select","Select",""],["","00406117003","NALTREXONE TAB","50MG","30","Select","Select",""],["","00228212750","CLONIDINE TAB","0.1MG","8","Select","Select",""],["","68462012605","GABAPENTIN TAB","600MG","1","Select","Select",""],["","00172572860","FAMOTIDINE TAB","20MG","15","Select","Select",""],["","00378210001","LOPERAMIDE CAP","2MG","12","Select","Select",""],["","49100036404","CULTURELLE CAP HLTH\/WEL","","30","Select","Select",""],["","31604001281","B","1 TAB 100MG","30","Select","Select",""],["","12496120803","SUBOXONE MIS","8-2MG","30","Select","Select",""],["","00087081941","BUSPAR TAB","10MG","90","Select","Select",""],["","23155050105","HYDROXYZ HCL TAB","25MG","90","Select","Select",""],["","00536137223","NICOTINE POL GUM","4MG MINT","100","Select","Select",""],["","72888001405","CYCLOBENZAPRINE HCL","10 MG","30","Select","Select",""],["","00603548321","PROPRANOLOL HCL","20 MG","60","Select","Select",""],["","00228202910","ALPRAZOLAM","0.5 MG","20","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":""}]}]}