{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" E EGROEGRJ EROOM","gend":0,"add":"RBKCOR 9001EUNEVA EGDI","city":"LYNCHBURG","state":"VA","zip":24501,"dob":"1964-09-13","age":"","mstatus":"","insh":"10119114","cliId":"","pno":"2443428966","cno":"","email":"","ename":"","eno":"","pphy":"ALBERS, GREGG","ppno":4344266982,"pcpadd":"118 OAKWOOD DR ,STE A","pcpcity":"MADISON HEIGHTS","pcpstate":"VA","pcpzip":24572,"pcpcounty":"","pcpid":"","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"WESTERN\/CHARLOTTESVILLE","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1009 ROCKBRIDGE AVENUE","madd2":"","madd3":"","mcity":"LYNCHBURG","mstate":"VA","mzip":"24501-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N18.6","D63.1","R52","U07.1","J32.9","J34.89","D86.9","R04.0","M54.50","G47.33","I27.81","R06.00","Z99.2","I10","R07.89","I13.2","D64.9","Z88.9","Z87.891","R91.8","R09.89","R07.9","I51.7","A41.89","R04.2","J12.82","J96.01","I16.1","D61.818","N25.81","E11.22","E11.40","I50.9","E78.5","D69.1","R59.0","I31.3","J90","D12.6","Z12.11","D12.2","D12.5","K64.0","K63.5","Z86.16","Z85.528","I50.32","J16.8","M54.16","M51.36","M43.06","M79.604","M79.605","F43.0","Z11.59","E11.9","R19.05","Z71.9","J31.0","G44.89","N28.1","I12.0","R09.02","R06.02","D86.0","D69.6","E88.09","M10.9","R77.8","Z86.14","Z79.52","Z91.15","Z86.19","N18.9","J98.4","R05","J81.1","K08.89","D50.9","I50.22","G47.30","Z99.89","E66.9","Z68.35","Z88.8","Z79.899","L72.3","L72.0","M19.90","Z90.5","Z88.6","Z82.49","Z86.39","J30.2","Z68.33","R22.2","I13.0","R51.9","R11.10","J32.0","Z76.89","G93.41","R41.82","I21.A1","Z20.822","I50.42","E83.52","T46.5X6A","K74.60","R53.1","G47.00","Z00.00","Z13.31","Z28.21","K76.89","R93.2","R79.89","Z23","R50.9","H25.13","H04.123","S32.040A","M51.37","M47.816","I42.8","M48.56XA","M51.26","C64.9","Z94.0","E11.69","Z79.4","Z48.298","T86.19","R42","Z48.22","D84.821","I50.30","Z85.828","R53.81","R19.7","I77.0","E88.9","N17.9","M79.89","R53.83","R73.03","I24.8","M47.817","T86.11","E11.65","S32.048A","X58.XXXA","Z91.89","N19","M47.896","M62.838","M54.06","D84.9","D62","D63.8","Z01.818","R06.89","Z45.2","E11.29","G92","I77.89"],"date":["2022-10-05","2022-10-05","2022-01-01","2022-11-05","2021-01-08","2021-01-18","2022-04-25","2021-01-18","2022-04-22","2022-02-28","2021-10-11","2021-04-01","2022-05-04","2022-08-03","2021-06-10","2022-07-05","2022-07-20","2021-01-30","2022-10-05","2022-04-26","2021-09-10","2021-06-10","2022-04-26","2021-02-03","2021-02-05","2021-02-02","2021-04-03","2021-09-12","2021-02-02","2021-09-10","2022-10-05","2021-06-10","2022-10-05","2022-04-26","2021-02-02","2021-04-01","2021-04-01","2022-04-26","2022-02-02","2022-02-02","2022-02-02","2022-02-02","2022-02-02","2022-02-02","2022-02-02","2022-05-24","2022-02-28","2021-02-03","2022-02-09","2022-02-09","2022-02-09","2022-02-09","2022-02-09","2022-03-23","2021-12-02","2022-08-03","2021-03-17","2021-03-03","2021-03-08","2021-03-17","2021-03-17","2022-10-05","2021-09-10","2021-04-03","2022-02-28","2021-09-12","2021-09-11","2021-04-01","2021-04-02","2021-04-01","2022-07-20","2021-04-03","2021-04-07","2022-07-20","2021-04-03","2021-09-10","2021-04-03","2021-05-27","2022-04-02","2022-02-28","2020-12-02","2020-12-02","2022-04-25","2022-04-25","2021-06-10","2022-10-05","2020-08-31","2020-09-15","2020-08-07","2022-04-25","2020-08-07","2020-12-03","2022-06-03","2021-08-09","2021-08-09","2020-08-13","2022-02-28","2021-09-12","2021-08-31","2021-08-31","2021-09-01","2021-09-13","2021-09-10","2021-09-10","2022-04-25","2021-09-10","2021-09-14","2021-09-10","2021-09-10","2021-09-10","2020-09-11","2020-09-11","2020-09-11","2020-09-11","2021-09-12","2021-09-12","2021-09-12","2022-10-05","2021-11-10","2020-11-11","2020-11-11","2021-11-15","2021-11-15","2022-03-23","2020-12-02","2021-12-23","2021-12-23","2022-02-28","2022-10-19","2022-10-05","2022-10-05","2022-05-16","2022-05-04","2021-08-31","2022-10-05","2022-07-20","2022-07-05","2022-07-20","2022-07-20","2022-07-20","2022-10-05","2022-07-20","2022-06-20","2022-06-20","2022-07-20","2022-04-22","2021-09-12","2022-02-23","2022-09-21","2022-10-05","2021-11-15","2021-11-15","2022-08-03","2022-05-24","2022-03-09","2022-03-09","2022-03-09","2022-04-29","2022-04-25","2022-04-25","2022-04-25","2022-04-25","2022-04-25","2022-06-17","2021-09-10","2022-05-01"],"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":[["","00955105027","SEVELAMER","TAB 800MG","720.00","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20.00","Select","Select",""],["","16714004107","ALLOPURINOL","TAB 100MG","30.00","Select","Select",""],["","68462068601","TACROLIMUS","CAP 1MG","120","Select","Select",""],["","16729026129","MYCOPHENOLIC","TAB 180MG DR","120","Select","Select",""],["","70710115001","ISOSORB","TAB 20MG","270.00","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100","Select","Select",""],["","73070010315","INSULIN","INJ FLEXPEN","15","Select","Select",""],["","00245531911","KLOR-CON","TAB 20MEQ ER","90","Select","Select",""],["","31722052101","HYDRALAZINE","TAB 50MG","270.00","Select","Select",""],["","10702022321","ATOVAQUONE","SUS 750\/5ML","210","Select","Select",""],["","68645055554","LISINOPRIL","TAB 40MG","90.00","Select","Select",""],["","00378064010","PREDNISONE","TAB 5MG","30.00","Select","Select",""],["","00093317431","ALBUTEROL","FAT E","8.50","Select","Select",""],["","00597015330","JARDIANCE","TAB 25MG","30","Select","Select",""],["","68645051654","AMLODIPINE","TAB 10MG","90.00","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","30.00","Select","Select",""],["","08290320109","BD  PEN NEEDL","MIS 31GX8MM","100","Select","Select",""],["","24689079302","CALC","CAP 667MG","540.00","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","15","Select","Select",""],["","68992301001","ENVARSUS","TAB 1MG","30","Select","Select",""],["","68382009405","CARVEDILOL","TAB 12.5MG","180.00","Select","Select",""],["","43547040211","FUROSEMIDE","TAB 40MG","90","Select","Select",""],["","50742026101","NIFEDIPINE","TAB 60MG ER","180","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","TES LITE","100","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","28.00","Select","Select",""],["","65162027110","SMZ-TMP","TAB 400-80MG","30","Select","Select",""],["","65862075360","VALGANCICLOV","TAB 450MG","30","Select","Select",""],["","00121086816","NYSTATIN","SUS 100000","280","Select","Select",""],["","00378668910","PANTOPRAZOLE","TAB 40MG","85","Select","Select",""],["","50111043301","TRAZODONE","TAB 50MG","30.00","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","15","Select","Select",""],["","65162062710","TRAMADOL","TAB 50MG","20","Select","Select",""],["","99073070805","FREESTYLE    KIT LITE","KIT LITE","1","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","10.00","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22.00","Select","Select",""],["","65862053750","LEVOFLOXACIN","TAB 500MG","3.00","Select","Select",""],["","59310057922","PROAIR","AER ","8.50","Select","Select",""],["","00310111030","LOKELMA","PAK 10GM","30","Select","Select",""],["","00093216568","NALOXONE","SPR ","2","Select","Select",""],["","00093117410","PENICILLN","TAB 500MG","30.00","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":""}]}]}