{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" F YMMATSDNOMDE","gend":1,"add":"         DAOR YLDNEIRF 91                         ","city":"WOODLAWN                 ","state":"VA","zip":"24381-3706","dob":"1974-12-17","age":"","mstatus":"","insh":"10110068","cliId":"","pno":"3267270907","cno":"","email":"","ename":"","eno":"","pphy":"ANDREA W RUPE","ppno":5409800550,"pcpadd":"101 1ST ST NW STE 2,","pcpcity":"Pulaski","pcpstate":"VA","pcpzip":243015605,"pcpcounty":"","pcpid":"","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"19 FRIENDLY ROAD                                  ","madd2":"                                                  ","madd3":"","mcity":"WOODLAWN                 ","mstate":"VA","mzip":"24381-3706","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N30.10","Z79.899","M46.1","G89.4","Z20.822","R19.7","F41.9","E03.9","E11.9","R10.9","R11.0","L28.2","L20.81","B35.1","R39.89","N39.3","R33.9","K92.1","R31.9","E78.5","Z51.81","L28.1","F41.1","F33.9","G47.9","R35.0","R39.15","R30.0","N32.81","N39.0","D50.9","Z00.00","Z68.38","Z72.3","E66.01","K59.04","Z79.84","R07.9","I10","R42","R53.1","F32.9","M62.81","N81.84","M62.838","N39.46","R10.2","N39.41","R25.2","Z91.81"," ","F33.1","E11.65","Z11.3"],"date":["2022-11-30","2022-09-20","2022-09-20","2022-09-20","2022-09-18","2022-01-19","2022-01-19","2022-10-05","2022-06-30","2022-01-19","2022-01-19","2022-05-23","2022-05-23","2022-01-24","2022-03-18","2022-12-01","2022-12-01","2022-12-01","2022-12-01","2022-10-05","2022-10-05","2021-10-28","2022-10-05","2022-05-25","2022-05-25","2022-05-24","2022-05-24","2022-10-21","2022-02-18","2022-11-30","2022-02-24","2022-02-24","2022-10-05","2022-10-05","2022-10-05","2022-10-05","2022-10-05","2022-04-26","2022-04-26","2022-04-26","2022-04-26","2022-04-26","2022-05-09","2022-05-09","2022-05-09","2022-05-09","2022-05-09","2022-05-24","2022-06-30","2022-06-30","2022-12-01","2022-10-05","2022-11-30","2022-10-24"],"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":[["","29300034401","BACLOFEN","TAB 20MG","120","Select","Select",""],["","00115180301","HYDROXYZ","CAP 25MG","180","Select","Select",""],["","16714069301","FLUCONAZOLE","TAB 200MG","2","Select","Select",""],["","68180097503","LEVOTHYROXIN","TAB 200MCG","30","Select","Select",""],["","16729004615","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","93365940","BUPRENORPHIN","DIS 20MCG\/HR","4","Select","Select",""],["","16729017201","AMITRIPTYLIN","TAB 25MG","30.00","Select","Select",""],["","65862056090","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","55111029298","SUMATRIPTAN","TAB 50MG","9.00","Select","Select",""],["","00228212710","CLONIDINE","TAB 0.1MG","60","Select","Select",""],["","68382004101","PROMETHAZINE","TAB 25MG","30","Select","Select",""],["","70700010917","CLOBETASOL","CRE 0.0005","120","Select","Select",""],["","00024591502","DUPIXENT","INJ 300\/2ML","4","Select","Select",""],["","16714033201","GABAPENTIN","TAB 800MG","120","Select","Select",""],["","57237001930","DULOXETINE","CAP 60MG","180.00","Select","Select",""],["","53746020401","OXYCOD\/APAP","TAB 10-325MG","120","Select","Select",""],["","23155002401","BUSPIRONE","TAB 10MG","180.00","Select","Select",""],["","16729000301","GLIMEPIRIDE","TAB 4MG","60.00","Select","Select",""],["","53885027150","ONETOUCH","TES VERIO","50","Select","Select",""],["","68180051201","LISINOPRIL","TAB 2.5MG","30.00","Select","Select",""],["","00002143380","TRULICITY","INJ 0.75\/0.5","2.00","Select","Select",""],["","69315090501","LORAZEPAM","TAB 1MG","60","Select","Select",""],["","57841130101","MOVANTIK","TAB 25MG","30","Select","Select",""],["","00591079501","DICYCLOMINE","TAB 20MG","120","Select","Select",""],["","59746017310","PREDNISONE","TAB 10MG","21","Select","Select",""],["","16714011002","HYDROXYCHLOR","TAB 200MG","21","Select","Select",""],["","65862064163","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","6505506","LAGEVRIO","CAP 200MG","40","Select","Select",""],["","65162027210","SMZ\/TMP","TAB 800-160","20.00","Select","Select",""],["","169633910","NOVOLOG","INJ FLEXPEN","15","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","20","Select","Select",""],["","65862051290","PIOGLITAZONE","TAB 15MG","30","Select","Select",""],["","29300022701","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","69315091001","DIPHEN\/ATROP","TAB ","30","Select","Select",""],["","57237023301","SMZ-TMP","TAB 800-160","10.00","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":["",""]}},{"a":{"indx":["1",""],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","",""],[""],[""],[""],[""]],"comment":[["","",""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}