{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" SAMOHTREDLE O","gend":0,"add":"F SDRAW 5844DR LLIM KRO","city":"Cullen","state":"VA","zip":"23934-9998","dob":"1948-09-05","age":"","mstatus":"","insh":"10110737","cliId":"","pno":"3843459908","cno":"","email":"","ename":"","eno":"","pphy":"ALBERS, GREGG","ppno":4343528235,"pcpadd":"131 JONES ST,","pcpcity":"Appomattox","pcpstate":"VA","pcpzip":"24522-9830","pcpcounty":"","pcpid":"","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"PO BOX 1187","madd2":"","madd3":"","mcity":"Pamplin","mstate":"VA","mzip":"23958-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I63.9","C20","I10","D50.9","I51.7","J98.11","J90","Z45.2","E87.70","R27.0","R41.81","I72.5","R91.8","K56.699","R11.10","K92.1","G89.18","R42","R14.0","R10.84","I25.10","I71.2","Z95.828","Z20.828","J98.8","Z43.2","Z48.815","Z93.2","F03.90","Z98.890","Z86.79","I67.1","G31.9","K52.9","L90.5","L08.9","Z85.048","Z98.0","A04.72","I69.354","K86.3","E78.5","E46","E55.9","R53.82","Z79.2","Z01.810","Z86.73","Z79.82","Z79.899","L57.0","R21","R41.89","R06.89","E87.79","D62","F05","R73.9","R91.1","I65.02","I67.2","Z46.82","I70.0","Z00.01","I69.998","Z71.89","Z71.3","E53.8","I65.1","R57.0","R57.1","J95.821","E87.8","Z01.30","R41.3","Z71.82","K92.2","N17.9","E87.2","E87.3","K43.5","Z08","Z28.311","Z93.3","M79.9","K80.20","T81.31XD","H26.9","Z91.81","R18.8","K62.5","I48.91","I45.81","I45.9","R06.02","Z01.812","Z20.822","R05","R55","Z88.0","E86.0","E87.6","Z90.49","I65.23","E87.4","D68.2","D69.59","I35.1","K76.0","N28.1","J30.2","D49.2","D49.9","D23.61","D23.62","D23.39","D23.4","L81.4","L82.1","D48.5","C44.1192","Z85.038","C44.310"],"date":["2023-07-05","2023-01-31","2023-06-13","2023-01-31","2021-03-15","2023-01-11","2021-03-18","2021-09-07","2021-03-11","2022-07-25","2022-07-25","2022-10-25","2021-09-13","2021-09-13","2021-09-12","2021-09-12","2021-09-13","2021-09-12","2021-09-12","2021-09-12","2022-11-10","2022-04-21","2021-04-29","2021-03-04","2021-03-04","2021-09-07","2021-11-01","2021-08-30","2023-06-13","2021-04-15","2023-05-22","2022-07-25","2022-07-25","2021-09-07","2021-09-07","2021-09-07","2022-07-20","2022-07-20","2021-11-01","2021-12-01","2021-12-01","2023-03-10","2021-12-01","2022-01-31","2021-11-01","2021-11-01","2021-02-15","2022-08-11","2021-12-01","2021-02-15","2023-03-20","2022-06-10","2022-06-10","2021-03-17","2021-03-11","2021-03-11","2021-03-11","2021-03-11","2021-09-08","2022-08-11","2022-08-11","2021-03-12","2021-06-07","2022-01-31","2022-04-21","2022-04-21","2022-04-21","2022-01-31","2022-11-23","2021-03-10","2021-03-09","2021-03-09","2021-03-09","2023-06-13","2022-07-26","2022-04-21","2021-09-13","2021-09-13","2021-03-10","2021-03-10","2021-09-07","2022-04-27","2022-04-27","2021-06-07","2021-06-07","2023-01-11","2021-12-01","2021-12-01","2021-12-01","2021-09-12","2021-09-12","2021-03-10","2021-03-10","2021-03-10","2021-03-17","2021-09-01","2021-09-01","2021-03-17","2021-03-17","2021-03-17","2021-09-13","2021-09-13","2021-09-13","2021-02-15","2021-03-09","2021-03-09","2021-03-09","2021-03-09","2023-01-11","2023-01-11","2023-04-11","2023-05-11","2023-05-10","2023-03-20","2023-03-20","2023-03-20","2023-03-20","2023-03-20","2023-06-13","2023-06-13","2023-05-22","2023-05-22","2023-06-13"],"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":[["","68180052001","LISINOP\/HCTZ","TAB 20-25MG","90","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","90","Select","Select",""],["","45802004064","SELENIUM SUL","LOT 0.025","120","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","10","Select","Select",""],["","70377002811","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","33342032915","TRIAMCINOLON","CRE 0.001","30","Select","Select",""],["","00054429931","FUROSEMIDE","TAB 40MG","21","Select","Select",""],["","52817036000","METOPROL TAR","TAB 25MG","60","Select","Select",""],["","00832532515","POT CL MICRO","TAB 20MEQ ER","21","Select","Select",""],["","65162062710","TRAMADOL HCL","TAB 50MG","12","Select","Select",""],["","65628020405","FIRVANQ","SOL 25MG\/ML","150","Select","Select",""],["","00093317431","ALBUTEROL SUL","FAT E","8.5","Select","Select",""],["","65862064163","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","76204020060","ALBUTEROL","NEB 0.00083","180","Select","Select",""],["","45802004064","SELENIUM","LOT 0.025","120","Select","Select",""],["","52817036000","METOPROL","TAB 25MG","60","Select","Select",""],["","00832532515","POT  CL MICRO","TAB 20MEQ ER","21","Select","Select",""],["","65162062710","TRAMADOL","TAB 50MG","12","Select","Select",""],["","68180052001","LISINOP\/HCTZ TAB","20-25MG","90","Select","Select",""],["","68180098003","LISINOPRIL TAB","10MG","90","Select","Select",""],["","45802004064","SELENIUM SUL LOT","2.5%","120","Select","Select",""],["","10702001801","OXYCODONE TAB","5MG","10","Select","Select",""],["","70377002811","ATORVASTATIN TAB","20MG","90","Select","Select",""],["","33342032915","TRIAMCINOLON CRE","0.1%","30","Select","Select",""],["","00054429931","FUROSEMIDE TAB","40MG","21","Select","Select",""],["","52817036000","METOPROL TAR TAB","25MG","60","Select","Select",""],["","00832532515","POT CL MICRO TAB","20MEQ ER","21","Select","Select",""],["","65162062710","TRAMADOL HCL TAB","50MG","12","Select","Select",""],["","65628020405","FIRVANQ SOL","25MG\/ML","150","Select","Select",""],["","00093317431","ALBUTEROL SULFATE","","8.5","Select","Select",""],["","65862064163","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","76204020060","ALBUTEROL NEB","0.083%","180","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":""}]}]}