{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"L   HAROBEDTLUAEBLIUG ","gend":1,"add":"             RD DOOWELGNAT 246                              ","city":"LYNCHBURG                     ","state":"VA","zip":"24502-5673","dob":"1957-04-25","age":"","mstatus":"","insh":"50010503","cliId":"","pno":"2543430275","cno":"","email":"","ename":"","eno":"","pphy":"BURROUGHS, JOEL                                             ","ppno":"","pcpadd":"925 Village Hwy","pcpcity":"Rustburg                      ","pcpstate":"VA","pcpzip":245884591,"pcpcounty":"","pcpid":"P9307471","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"642 TANGLEWOOD DR                                           ","madd2":"                                                            ","madd3":"","mcity":"LYNCHBURG                     ","mstate":"VA","mzip":"24502-5673","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","E78.2","I10","R25.1","E78.5","K21.9","Z13.31","N39.41","J01.90","R51","E83.52","R19.7","E67.2","H25.11","H25.13","H43.823","E11.3293","E11.36","Z20.828","E78.00","J45.909","F41.9","M19.90","Z79.84","Z79.02","H25.12","Z12.11","K57.30","J30.9","E11.65","Z20.822"],"date":["2021-06-04","2019-03-22","2021-06-04","2021-03-05","2021-06-11","2020-02-21","2020-02-21","2020-02-21","2020-02-21","2020-02-21","2020-03-06","2020-05-27","2020-05-27","2020-10-13","2020-10-02","2020-10-02","2020-10-02","2020-10-06","2021-09-03","2020-10-06","2020-10-06","2020-10-06","2020-10-06","2020-10-06","2020-10-06","2020-11-17","2020-11-06","2020-11-06","2021-03-05","2021-06-11","2021-11-02"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","69097081312","GABAPENTIN","100MG","60","Select","Select",""],["","00193658621","MICROLET","LANCETS","100","Select","Select",""],["","00115166003","PROPRANOLOL","20MG","60","Select","Select",""],["","65862057490","MONTELUKAST","10MG","30","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","00193654621","BAYER","LANCETS","100","Select","Select",""],["","68382002310","ATENOLOL","50MG","30","Select","Select",""],["","49281042050","FLUZONE","2020-21","0.5","Select","Select",""],["","24208060203","PROLENSA","0.07%","3","Select","Select",""],["","61314063710","PREDNISOLONE","1% OP","10","Select","Select",""],["","50458014130","INVOKANA","300MG","30","Select","Select",""],["","70377002811","ATORVASTATIN","20MG","30","Select","Select",""],["","65862086001","FAMOTIDINE","40MG","30","Select","Select",""],["","65862035790","CLOPIDOGREL","75MG","30","Select","Select",""],["","76385012810","METFORMIN","500MG ER","120","Select","Select",""],["","00006027731","JANUVIA","100MG","30","Select","Select",""],["","68180098003","LISINOPRIL","10MG","30","Select","Select",""],["","00193708050","CONTOUR","BLD GLUC","50","Select","Select",""],["","60758061525","GATIFLOXACIN","0.50%","2.5","Select","Select",""],["","45802091987","CETIRIZINE","10MG","30","Select","Select",""],["","59779030603","CVS","","510","Select","Select",""],["","50428166363","BISACODYL","5MG EC","2","Select","Select",""],["","00310621030","FARXIGA","10MG","30","Select","Select",""],["","65862050320","AMOX\/K","875-125","14","Select","Select",""],["","59779076678","PAIN","325MG","100","Select","Select",""],["","00904671980","ACETAMINOPHEN","B 325","100","Select","Select",""],["","57896010210","ACETAMINOPHE","325MG","100","Select","Select",""],["","68180098003","LISINOPRIL ","TAB 10MG","30","Select","Select",""],["","69097081312","GABAPENTIN ","CAP 100MG","60","Select","Select",""],["","00193658621","MICROLET ","MIS LANCETS","100","Select","Select",""],["","00115166003","PROPRANOLOL ","TAB 20MG","60","Select","Select",""],["","65862057490","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","00193654621","BAYER ","MIS LANCETS","100","Select","Select",""],["","68382002310","ATENOLOL ","TAB 50MG","30","Select","Select",""],["","49281042150","FLUZONE ","INJ 2021-22","0.5","Select","Select",""],["","00005197102","PREVNAR ","INJ ","0.5","Select","Select",""],["","70010049110","METFORMIN ","TAB 500MG ER","360","Select","Select",""],["","24208060203","PROLENSA ","SOL 0.0007","3","Select","Select",""],["","61314063710","PREDNISOLONE ","SUS 1% OP","10","Select","Select",""],["","50458014130","INVOKANA ","TAB 300MG","30","Select","Select",""],["","70377002811","ATORVASTATIN ","TAB 20MG","30","Select","Select",""],["","65862086001","FAMOTIDINE ","TAB 40MG","30","Select","Select",""],["","65862035790","CLOPIDOGREL ","TAB 75MG","30","Select","Select",""],["","00006027731","JANUVIA ","TAB 100MG","30","Select","Select",""],["","00193708050","CONTOUR ","TES BLD GLUC","50","Select","Select",""],["","60758061525","GATIFLOXACIN ","SOL 0.005","2.5","Select","Select",""],["","45802091987","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","59779030603","CVS ","POW ","510","Select","Select",""],["","50428166363","BISACODYL ","TAB 5MG EC","2","Select","Select",""],["","00310621030","FARXIGA ","TAB 10MG","30","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","14","Select","Select",""],["","59779076678","PAIN ","TAB 325MG","100","Select","Select",""],["","00904671980","ACETAMINOPHEN ","TA B 325","100","Select","Select",""],["","57896010210","ACETAMINOPHE ","TAB 325MG","100","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}