{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" EINAHPETSYRREP C  ","gend":1,"add":"LED 4901ENAL IHP","city":"CHARLOTTESVILLE               ","state":"VA","zip":"22911-3649","dob":"1976-12-27","age":"","mstatus":"","insh":"50018762","cliId":"","pno":"8943455021","cno":4344140327,"email":"","ename":"","eno":"","pphy":"CHRISTENSEN, MARISA","ppno":5409421200,"pcpadd":"1242 Cedars Ct,","pcpcity":"Charlottesville               ","pcpstate":"VA","pcpzip":229034800,"pcpcounty":"","pcpid":"","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"1094 DELPHI LANE","add3":"","madd1":"1094 DELPHI LANE","madd2":"                                                            ","madd3":"","mcity":"CHARLOTTESVILLE               ","mstate":"VA","mzip":"22911-3649","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.6","R06.02","R07.9","R09.1","J45.909","F31.9","G40.909","E03.9","I47.1","Z86.14","Z87.891","Z79.899","Z88.6","Z88.8","R07.81","G47.00","G43.109","Z87.898","R56.9","G43.909","G43.019","G43.709","R10.84","J45.21","J01.00","J45.901","J06.9","R51","R05","R06.2","M25.572","M54.2","G89.29","M79.89","F31.10","Z04.6","Z59.8","Z87.820","F43.10","F23","F29","I10","F10.10","F06.34","R68.89","D72.829","Z00.00","Z23","Z12.4","Z12.39","Z11.3","E87.8","J30.2","R03.0","F32.9","Z30.09","R87.610","N72","R87.810","Z20.2","N88.2","Z91.89","Z30.430","Z53.8","R09.81","J31.0","T48.5X5A","H92.09","J32.9","S02.2XXA","T84.028A","H92.01","M47.812","Z98.1","R53.83","T14.8XXA","R60.9","K59.00","S12.100A","M96.0","Z01.818","R93.7","T84.216A","Z87.81","M50.30","F41.1","F41.0","F33.41","F50.9","F10.20","F12.20","R11.0","R19.7","Z01.419","Z77.21","Z30.011","Z12.31","Z30.41","Z87.410","R79.89"],"date":["2020-05-11","2019-08-08","2019-08-07","2019-02-13","2020-05-03","2020-05-03","2020-05-03","2021-08-30","2019-09-08","2019-08-08","2019-09-08","2019-09-08","2019-09-08","2019-09-08","2019-02-13","2019-04-15","2019-04-15","2019-04-15","2020-05-02","2020-08-18","2019-04-15","2019-04-15","2019-04-15","2020-05-11","2019-04-19","2019-08-08","2019-08-07","2019-08-07","2019-08-08","2019-08-08","2019-09-12","2020-12-21","2019-09-08","2019-09-12","2020-05-02","2020-05-02","2020-05-02","2020-05-03","2020-05-05","2020-05-03","2020-05-03","2020-05-03","2020-05-04","2020-05-04","2020-05-04","2020-05-11","2020-05-11","2021-04-16","2021-08-23","2020-05-11","2020-05-11","2020-05-11","2020-05-11","2020-05-26","2020-05-11","2020-05-11","2021-08-23","2020-07-16","2021-08-23","2021-08-23","2020-07-31","2020-07-29","2020-07-31","2020-07-31","2020-09-08","2020-09-23","2020-09-08","2020-09-18","2020-09-18","2020-09-18","2020-09-18","2020-09-23","2020-12-04","2020-12-23","2020-10-01","2020-10-01","2020-10-01","2020-10-01","2020-12-04","2020-12-04","2020-12-21","2020-12-21","2020-12-23","2020-12-23","2020-12-23","2021-02-03","2021-02-03","2021-02-03","2021-02-03","2021-02-03","2021-02-03","2021-04-01","2021-04-01","2021-08-30","2021-08-30","2021-08-23","2021-08-23","2021-08-23","2021-08-23","2021-08-30"],"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":[["","69097012403","TOPIRAMATE","TAB 100MG","90","Select","Select",""],["","69097083412","SERTRALINE","TAB 50MG","60","Select","Select",""],["","65162052110","PROMETHAZINE","TAB 25MG","30","Select","Select",""],["","00378180310","LEVOTHYROXIN","TAB 50MCG","90","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","67877026118","RIZATRIPTAN","TAB 5MG","10","Select","Select",""],["","68462030529","NORETHINDRON","TAB 0.35MG","84","Select","Select",""],["","16729008110","NALTREXONE","TAB 50MG","90","Select","Select",""],["","10702001150","HYDROXYZ","TAB 25MG","90","Select","Select",""],["","65862015901","ZOLPIDEM","TAB 5MG","30","Select","Select",""],["","45802091987","CETIRIZINE","TAB 10MG","90","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","50428125507","CVS","SPR 0.0005","90","Select","Select",""],["","60505025203","TIZANIDINE","TAB 4MG","30","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","6.7","Select","Select",""],["","00603188016","LIDOCAINE","PAD 0.05","10","Select","Select",""],["","00254200801","COLCHICINE","TAB 0.6MG","30","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","30","Select","Select",""],["","49281042050","FLUZONE","INJ 2020-21","0.5","Select","Select",""],["","58160084211","BOOSTRIX","INJ ","0.5","Select","Select",""],["","00006411903","GARDASIL","INJ ","0.5","Select","Select",""],["","70954001910","PRAZOSIN","CAP 1MG","30","Select","Select",""],["","59762500801","MISOPROSTOL","TAB 200MCG","2","Select","Select",""],["","00228202950","ALPRAZOLAM","TAB 0.5MG","90","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","30","Select","Select",""],["","55111029336","SUMATRIPTAN","TAB 100MG","6","Select","Select",""],["","71093014105","METHOCARBAM","TAB 750MG","30","Select","Select",""],["","65862022960","LAMOTRIGINE","TAB 150MG","60","Select","Select",""],["","59779001951","ALLERGY","CAP 25MG","30","Select","Select",""],["","69097086107","ZONISAMIDE","CAP 100MG","60","Select","Select",""],["","53489011905","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","00591544305","PREDNISONE","TAB 20MG","10","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","12","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":""}]}]}