{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" EMOREJSTREBOR","gend":0,"add":" DER 6718DR ESUOH","city":"RED HOUSE                ","state":"VA","zip":"23963-9998","dob":"1962-10-11","age":"","mstatus":"","insh":"10117617","cliId":"","pno":"1225282063","cno":4346648325,"email":"","ename":"","eno":"","pphy":"CARMACK, JOHN F","ppno":4343528235,"pcpadd":"131 JONES ST,","pcpcity":"Appomattox","pcpstate":"VA","pcpzip":245229830,"pcpcounty":"","pcpid":"","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"APT 4","add3":"","madd1":"PO BOX 163","madd2":"                                                  ","madd3":"","mcity":"RED HOUSE                ","mstate":"VA","mzip":"23963-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N18.9","R11.2","R10.9","I25.118","E78.49","I11.0","I50.32","R06.02","G47.33","G81.94","E11.9","H57.12","Z74.3","E11.42","Z71.89","Z71.3","R15.9","R19.7","M17.12","N18.1","M54.40","R06.89","R91.8","R07.9","R93.89","R07.2","R53.1","R53.81","R51.9","I12.9","E11.22","E66.01","Z79.51","Z79.82","Z79.899","Z88.5","N17.9","I10","Z88.8","Z79.4","E11.40","L60.3","L85.1","L60.0","M79.609","E11.618","I69.30","Z01.30","Z91.81","M54.5","R60.0","Z88.6","M50.321","M48.02","M54.9","M51.36","M51.26","M48.061","M40.204","M85.80","L03.213","M79.604","M79.605","G89.29","R52","W19.XXXA","I66.01","M62.81","R47.81","X30.XXXA","G93.49","Z68.42","E87.1","E86.0","R42","R09.02","N18.30","R00.0","Z86.73","Z68.43","K58.9","Z82.0","Z82.49","I65.23","I66.02","I65.1","K42.9","R11.10","I08.2","Z90.49","R10.13","Z20.822","M79.672","M72.2","A41.9","R11.0","S91.311A","M22.40","R07.89","K59.1","R11.11","K58.0","J45.909","S80.01XA","S80.02XA","S60.041A","S43.402A","T14.8XXA","N18.2","S89.92XA","S89.91XA","S69.92XA","S69.91XA","R79.89","I67.82","I63.9","E11.3593","H20.012","H40.1132","E11.39","R68.89","I65.21","R22.0","K76.0","M79.89","J98.11","R09.89","M54.16","M54.50","M54.41","E13.69","R22.43","R10.84","R55","Z23","J98.8","N12","E08.42","J01.00","R04.0","M54.59","S39.012A","X58.XXXA","M48.07","M47.817","E66.9","S39.92XA","M51.37","M47.816","Z78.9","E11.649","R53.83","T14.8","R94.31","E11.65","Z13.1","M65.351","W57.XXXD","R73.9","E78.5","S96.911A","W01.0XXA","Y93.9","Y92.009","I69.352","I67.89","Q21.1","I69.322","I69.398","R26.89","Z74.1","Z74.09","H54.62","I63.89","G43.909","R29.818","S19.9XXA","S09.90XA","R29.898","M21.379","M25.552","Y93.89","R00.2","E87.5","Z79.02","K21.9","I66.03","I69.354","R29.709","R29.810","R40.4","I95.9","S79.812A","S99.911A","S29.9XXA","R90.89","M51.34","R00.1","Z95.818","I25.10","G44.89","Z68.41","J98.4","T44.7X1A","I95.2","M50.222","M50.30","I67.1","R40.20","E11.3551","H26.132","I63.22","E87.20","G93.40","N39.0","Q21.12","K30","R14.0","R47.1","I67.9","R93.1","J32.0","J32.2","M46.1"],"date":["2022-10-31","2022-02-02","2022-06-22","2022-01-12","2022-01-12","2022-01-31","2022-01-31","2022-10-25","2022-11-01","2022-01-12","2022-08-01","2022-01-20","2022-02-02","2022-09-19","2022-09-19","2022-09-19","2021-01-28","2022-04-27","2021-05-09","2021-12-16","2021-12-16","2022-06-14","2022-07-28","2022-07-20","2022-06-25","2021-08-23","2022-10-25","2022-07-08","2022-07-18","2022-10-25","2022-10-25","2022-07-20","2021-08-23","2022-07-19","2022-07-28","2022-07-28","2022-11-01","2022-10-31","2022-07-28","2022-10-25","2022-08-05","2022-08-05","2022-08-05","2022-08-05","2022-08-05","2021-05-05","2021-05-05","2022-09-19","2022-07-07","2022-06-02","2021-12-20","2021-08-02","2021-12-21","2022-07-31","2022-07-18","2022-02-17","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2022-01-20","2021-02-16","2022-03-15","2021-02-16","2022-07-18","2022-07-18","2021-08-13","2022-04-21","2022-06-14","2021-08-13","2021-08-13","2022-07-28","2022-11-01","2021-08-16","2022-04-27","2022-07-28","2022-06-14","2022-11-01","2022-10-31","2021-08-15","2021-08-15","2021-08-15","2021-08-15","2021-12-21","2022-07-28","2022-07-28","2022-02-02","2022-02-02","2022-01-31","2022-02-02","2022-02-02","2022-11-01","2021-05-17","2021-05-17","2021-08-23","2022-07-16","2021-02-02","2021-02-02","2022-02-08","2021-03-01","2021-03-12","2022-07-07","2022-06-19","2021-05-06","2021-05-06","2021-05-06","2021-05-06","2021-05-06","2021-05-06","2021-05-09","2021-05-09","2021-05-09","2021-05-09","2021-07-07","2022-08-01","2022-10-26","2021-11-19","2021-11-19","2022-02-24","2021-11-19","2021-11-28","2022-01-20","2022-01-20","2021-07-07","2021-08-01","2022-10-25","2022-10-25","2021-11-28","2022-06-02","2021-11-28","2021-11-28","2021-12-21","2021-01-15","2021-09-16","2021-11-11","2021-01-13","2021-01-16","2022-08-05","2021-12-08","2021-12-20","2022-04-21","2022-03-15","2022-03-15","2022-03-15","2022-03-15","2022-08-01","2022-07-18","2022-03-15","2022-03-15","2021-04-07","2022-04-27","2022-04-27","2021-12-16","2022-07-28","2022-10-31","2022-06-02","2022-09-19","2022-06-02","2022-07-16","2022-10-31","2022-07-20","2022-07-20","2022-07-20","2022-07-20","2022-07-07","2022-07-05","2022-07-28","2022-06-19","2022-07-28","2022-06-19","2022-06-19","2022-06-19","2022-07-28","2022-06-24","2022-07-16","2022-07-16","2022-07-31","2022-07-18","2022-08-01","2022-08-05","2022-07-18","2022-07-18","2022-10-04","2022-07-19","2022-10-25","2022-07-18","2022-06-14","2022-07-28","2022-06-14","2022-06-14","2022-07-28","2022-08-01","2022-07-18","2022-07-18","2022-07-18","2022-06-15","2022-07-18","2022-08-01","2022-08-01","2022-10-31","2022-07-16","2022-11-01","2022-10-25","2022-07-28","2022-07-28","2022-07-31","2022-07-31","2022-07-29","2022-07-28","2022-02-24","2022-02-24","2022-11-01","2022-11-01","2022-11-01","2022-11-01","2022-11-01","2022-11-01","2022-10-25","2022-10-28","2022-10-31","2022-10-31","2022-10-26","2022-10-26","2022-02-17"],"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":[["","65862001401","AMOXICILLIN","TAB 500MG","10","Select","Select",""],["","64980043501","MIDODRINE","TAB 10MG","90","Select","Select",""],["","61442010310","DICLOFENAC","TAB 75MG DR","20","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","59762106101","DIPHEN\/ATROP","TAB 2.5MG","20","Select","Select",""],["","65862056099","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","08470359001","UNIFINE","MIS 31GX6MM","90","Select","Select",""],["","00597015230","JARDIANCE","TAB 10MG","90","Select","Select",""],["","16714087703","ATORVASTATIN","TAB 80MG","90","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","90","Select","Select",""],["","69097042107","CELECOXIB","CAP 200MG","60","Select","Select",""],["","73070010315","INSULIN","INJ FLEXPEN","15","Select","Select",""],["","65862035705","CLOPIDOGREL","TAB 75MG","90","Select","Select",""],["","50111039801","HYDRALAZINE","TAB 10MG","270","Select","Select",""],["","00378210001","LOPERAMIDE","CAP 2MG","20","Select","Select",""],["","53746010905","HYDROCO\/APAP","TAB 5-325MG","2","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA","100","Select","Select",""],["","65862016899","ATENOLOL","TAB 25MG","30","Select","Select",""],["","65162062711","TRAMADOL","TAB 50MG","30","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","15","Select","Select",""],["","65162052111","PROMETHAZINE","TAB 25MG","12","Select","Select",""],["","68382014601","RAMIPRIL","CAP 5MG","90","Select","Select",""],["","59762004801","TOLTERODINE","CAP 4MG ER","90","Select","Select",""],["","08222095855","PEN  NEEDLES","MIS 31GX8MM","450","Select","Select",""],["","67877022401","GABAPENTIN","CAP 400MG","360","Select","Select",""],["","69097012415","TOPIRAMATE","TAB 100MG","180","Select","Select",""],["","60505317007","OMEGA-3-ACID","CAP 1GM","360","Select","Select",""],["","76204020060","ALBUTEROL","NEB 0.00083","1,080.00","Select","Select",""],["","57237001930","DULOXETINE","CAP 60MG","90","Select","Select",""],["","00078090438","SIMBRINZA","SUS 1-0.2%","8","Select","Select",""],["","70710116201","MECLIZINE","TAB 25MG","60","Select","Select",""],["","47781019605","OXYCOD\/APAP","TAB 5-325MG","30","Select","Select",""],["","08290320109","BD  PEN NEEDL","MIS 31GX8MM","100","Select","Select",""],["","57664050318","TIZANIDINE","TAB 4MG","30","Select","Select",""],["","23155050205","HYDROXYZ","TAB 50MG","90","Select","Select",""],["","43547040211","FUROSEMIDE","TAB 40MG","90","Select","Select",""],["","00093227534","AMOX\/K","TAB 875-125","20.00","Select","Select",""],["","00143980305","DOXYCYCL","CAP 100MG","20.00","Select","Select",""],["","24208083060","NEO\/POLY\/DEX","SUS 0.1% OP","5","Select","Select",""],["","00185005501","METOLAZONE","TAB 5MG","5","Select","Select",""],["","67877025145","TRIAMCINOLON","CRE 0.001","454","Select","Select",""],["","00002143380","TRULICITY","INJ 0.75\/0.5","2","Select","Select",""],["","00527169505","BUT\/APAP\/CAF","TAB ","30","Select","Select",""],["","42858011830","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","23155065201","METRONIDAZOL","TAB 500MG","21","Select","Select",""],["","00193731150","CONTOUR","TES NEXT","100","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":""}]}]}