{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DLANIGERSENOJ K ","gend":0,"add":"REPSAJ 843DAOR DOOW ","city":"HURT","state":"VA","zip":"24563-9998","dob":"1959-11-27","age":"","mstatus":"","insh":"00112915","cliId":"","pno":"8775721972","cno":"4344852301","email":"","ename":"","eno":"","pphy":"BROSE, TEODORA G","ppno":"4343528235          ","pcpadd":"131 Jones St, ","pcpcity":"131 Jones St,","pcpstate":"VA","pcpzip":"245229830","pcpcounty":"","pcpid":"","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"LOT 3","add3":"","madd1":"348 JASPER WOOD ROAD","madd2":"LOT 3","madd3":"","mcity":"HURT","mstate":"VA","mzip":"24563-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R07.89","R79.89","I47.2","I25.10","I25.2","J44.9","I42.8","I11.0","I50.20","D72.819","E78.5","R73.9","Z43.1","T85.528A","Y73.2","I10","Z79.01","Z87.891","R06.02","R07.9","F41.9","F43.21","K94.23","Z85.818","Z71.9","R62.7","C32.9","R13.19","K02.9","J34.2","Z85.21","J98.4","R91.8","R06.89","I21.4","I82.409","C14.0","Z86.711","R50.9","J37.0","Z92.3","M54.5","M62.89","M47.816","M47.817","Z51.0","C32.1","D68.59","F19.10","L59.8","K20.9","Z92.21","Z08","R13.12","G89.3","Z93.1","K08.9","Z86.718","K21.9","Z79.82","I42.9","Z79.899","R23.8","R22.1","Z45.2","R07.81","Z00.00","T85.848A","M79.672","H04.129","R68.89","K59.00","R10.9","Z20.828","E78.00","I82.509","F14.11","Z20.822","Z23","C49.9","R20.0","Z88.6","R63.4","R89.9","C76.0","R49.0","G89.29","I70.0","K04.7","K56.41","K76.0","N28.1","Z80.9","Z82.49","R10.32","K92.1","I26.99","Z74.3","R93.2","R10.30","Z46.59","I50.33","F17.210","Z71.6","M25.511","Z77.123","Y73.1","R11.0","K76.89","R20.2","R04.2","Z86.16","R07.2","Z12.5","R10.11","R93.89","Z51.11","Z01.818","R10.84","T85.9XXA","J98.11","F10.10","R42","R53.83","I25.810","Z85.819","I50.9","Z91.048","Z95.1","J38.3","R09.89","R52","D70.9","E55.9","R13.13","H61.21","Z13.31","I20.0","R93.1","U07.1","K46.9","Z00.01","E46","R91.1","M46.1","R53.1","J92.9","J02.9","R05","I95.9","F10.229","R77.8","M79.642","R10.12"],"date":["2022-01-22","2022-01-25","2022-01-25","2022-01-05","2022-01-05","2022-02-16","2022-01-05","2022-01-05","2022-01-05","2022-01-05","2022-01-05","2022-01-05","2019-01-09","2019-01-08","2019-01-08","2022-03-24","2022-01-22","2022-01-22","2022-01-27","2022-01-27","2022-02-16","2022-01-27","2019-02-04","2019-02-04","2019-02-22","2019-02-07","2022-01-31","2022-02-03","2019-05-20","2021-03-23","2022-02-03","2022-01-22","2022-01-27","2022-01-27","2021-04-07","2021-04-07","2021-04-07","2021-10-18","2021-04-07","2021-03-23","2020-08-16","2020-11-09","2020-09-28","2020-11-09","2020-11-09","2018-11-01","2021-10-26","2021-12-22","2018-11-01","2018-11-01","2018-11-01","2021-04-06","2018-12-03","2019-07-11","2022-02-16","2019-03-20","2019-03-20","2022-01-05","2021-12-22","2021-04-06","2021-05-19","2022-01-15","2019-01-12","2019-01-12","2022-01-15","2022-01-27","2021-09-08","2019-05-15","2021-05-17","2022-01-13","2022-01-31","2020-12-23","2021-07-14","2020-09-09","2021-12-22","2021-12-22","2022-01-05","2022-01-25","2022-01-13","2019-02-01","2021-03-25","2021-04-06","2019-04-26","2021-06-11","2021-11-09","2021-11-09","2020-12-23","2021-07-14","2020-08-16","2020-08-16","2021-07-14","2021-07-14","2020-08-16","2021-08-19","2021-09-08","2021-09-08","2021-09-08","2021-10-18","2020-11-11","2020-12-04","2019-01-09","2022-01-15","2021-10-18","2019-01-25","2022-01-25","2022-01-31","2019-05-15","2022-01-22","2020-08-17","2020-08-17","2021-08-19","2021-09-01","2021-10-18","2020-10-19","2020-10-19","2020-11-11","2018-11-12","2018-12-17","2019-01-09","2019-01-09","2021-01-24","2022-01-25","2022-01-25","2021-07-22","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-11-09","2020-12-23","2021-01-24","2019-01-25","2019-02-07","2021-03-23","2021-07-15","2021-08-13","2020-08-19","2020-08-19","2021-08-19","2020-09-09","2020-09-09","2020-09-09","2022-01-05","2019-05-17","2020-08-17","2021-08-19","2021-08-19","2021-08-19","2018-12-21","2022-01-22","2022-01-22","2022-02-16","2022-03-24"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"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":[["","16714071503","OMEPRAZOLE","CAP 20MG","90.00","Select","Select",""],["","16714087603","ATORVASTATIN","TAB 40MG","30.00","Select","Select",""],["","45802016000","DICLOFENAC","GEL 0.01","100.00","Select","Select",""],["","00003089421","ELIQUIS","TAB 5MG","60.00","Select","Select",""],["","57664049983","MIRTAZAPINE","TAB 15MG","90.00","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8.50","Select","Select",""],["","65862018730","ONDANSETRON","TAB 4MG","60.00","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","946.00","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16.00","Select","Select",""],["","60432070605","OXYCODONE","SOL 5MG\/5ML","300.00","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21.00","Select","Select",""],["","59310057922","PROAIR","AER ","8.50","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","5.00","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","20.00","Select","Select",""],["","16714085201","METOPROL","TAB 25MG ER","90.00","Select","Select",""],["","57664037718","TRAMADOL","TAB 50MG","120.00","Select","Select",""],["","00548560300","ENOXAPARIN","INJ 60\/0.6ML","1.80","Select","Select",""],["","57237004101","PENICILLN","TAB 500MG","28.00","Select","Select",""],["","68645014059","FAMOTIDINE","TAB 20MG","60.00","Select","Select",""],["","00832105415","BACLOFEN","TAB 10MG","60.00","Select","Select",""],["","59746017310","PREDNISONE","TAB 10MG","20.00","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","21.00","Select","Select",""],["","65862037405","ESCITALOPRAM","TAB 10MG","30.00","Select","Select",""],["","64380074108","BUSPIRONE","TAB 5MG","60.00","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":["",""]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"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":""}]}]}