{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JANE   M WITCHER","gend":1,"add":"646 CRESCENT DRIVE","city":"CONCORD                       ","state":"VA","zip":"24538-9998","dob":"1991-09-19","age":"","mstatus":"","insh":3212031,"cliId":"","pno":4346647076,"cno":"","email":"","ename":"","eno":"","pphy":"BROSE, TEODORA G","ppno":4343528235,"pcpadd":"131 Jones St,","pcpcity":"Appomattox                    ","pcpstate":"VA","pcpzip":245229830,"pcpcounty":"","pcpid":"","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"646 CRESCENT DRIVE","add3":"","madd1":"646 CRESCENT DRIVE","madd2":"","madd3":"","mcity":"CONCORD                       ","mstate":"VA","mzip":"24538-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.81","N30.00","R19.7","R51","J45.30","T78.40XS","Z91.013","D64.9","R10.9","R10.30","R11.2","G89.29","G44.89","J32.0","S93.402A","S93.401A","S93.402D","S99.912D","R50.9","M25.572","R60.0","I10","R51.9","F41.9","R10.84","R63.4","R10.32","R53.1","R25.3","G37.9","G95.9","R32","R41.3","S69.92XA","J45.909","T76.11XA","G81.91","S16.1XXA","R53.83","R29.898","R42","Z11.59","E03.8","E06.3","R94.4","M79.10","K58.0","K08.89","R69","M25.521","S53.401A","W01.0XXA","Y92.89","S59.901A","K31.89","K22.8","K52.9","K92.1","K64.8","K64.4","Z12.11","Z80.0","M54.5","M54.6","S39.012A","N83.202","Z90.49","Z90.89","S19.9XXA","S09.90XA","T74.21XA","E87.6","Z86.16","B02.9","F32.9","T76.21XA","U07.1","R11.0","F33.2","Z20.822","F41.0","T43.592A","F84.0","T42.4X2A","R48.0","F43.12","E03.9","R45.851","F43.10","R55","M54.2","Z79.899","Z88.5","J32.3","T50.904A","F33.1","T50.902A","S09.8XXA","R94.31","Z91.410","R10.31","W10.8XXA","Y09","S39.93XA","S39.91XA","R05.9","Z46.82","R40.20","T68.XXXA","R40.4","R06.89","T88.7XXA","R41.82","J96.01","G92.9","M62.82","T40.992A","R23.0","F32.A","G93.40","R56.9","R58","R00.0","T65.91XA","Y92.9","V89.2XXA","Y93.9","J96.90","S29.9XXA","R14.0","K59.00","S39.92XA","T50.901A","V47.5XXA","Y92.415","J15.212","S10.93XA","Z53.29","M25.511","R06.02","J18.9","S40.011A","S49.91XA","Z91.19","F60.3","G43.909","Z82.49","Z88.8","G25.79","N39.0","G25.89","T43.595A","Z79.890","H53.8","T44.3X5A","F17.200","Z86.14","G25.2","T50.995A","Z88.6","F39","R29.818","S50.02XA","M25.522","O26.891","R10.2","O99.331","Z3A.11","O99.89","O34.219","O99.351","O99.341","O21.9","O98.311","A60.00","O09.91","Z31.5","B00.9","O09.90","O99.340","Z34.91","O26.892","O09.92","Z13.79","Z3A.15","O99.342","O99.332","Z3A.16","R31.9","E87.1","N13.30","E87.2","O99.282","N23","R33.9","O99.512","Z34.90","O26.832","R68.89","O99.352","Z3A.17","K21.9","O98.512","Z3A.18","O98.312","O28.3","Z3A.21","O99.612","O34.211","O99.212","Z36.3","Z36.2","Z36.8A","Z36.9","O26.893","R30.0","O34.593","O99.343","Z3A.28","Z03.74","O09.93","Z00.00","O26.899","Z53.21","O21.1","E86.0","W18.30XA","Z3A.29","J32.4","O99.513","O99.353","A04.72","O99.013","O98.813","Z34.83","O16.3","Z3A.30","O99.283","O76","Z79.51","Z87.442","Z34.81","Z3A.31","R03.0","O99.613","K04.7","Z3A.34","O36.8130","Z3A.35","O13.4","O99.02","O99.344","Z37.0","Z3A.36","Z30.2","O69.81X0","O34.212","O75.4","N99.4","O90.89","Z39.2","R10.11","G89.18","R20.2","S46.911A"],"date":["2022-04-06","2020-02-06","2021-07-08","2020-02-06","2021-05-12","2020-02-06","2020-02-06","2020-02-06","2022-01-27","2020-02-06","2022-03-20","2021-07-08","2021-05-12","2020-04-10","2020-04-12","2021-12-11","2020-04-15","2020-04-15","2020-04-15","2020-11-06","2020-04-28","2021-05-12","2022-01-31","2022-02-23","2021-05-25","2021-05-25","2021-01-29","2022-03-20","2021-03-24","2021-04-07","2021-03-24","2021-03-24","2021-03-24","2021-03-29","2022-03-20","2021-03-29","2021-04-07","2022-02-06","2021-05-12","2021-04-09","2021-04-09","2021-05-12","2021-05-12","2021-05-12","2021-05-12","2021-05-25","2021-05-12","2021-05-27","2021-06-15","2021-06-15","2021-06-15","2021-06-15","2021-06-15","2022-03-01","2022-02-23","2021-07-08","2021-07-08","2021-07-08","2021-07-08","2021-07-08","2021-07-26","2021-07-26","2021-07-31","2021-07-31","2021-07-31","2022-01-27","2022-02-23","2022-01-27","2022-02-28","2022-02-23","2022-01-27","2022-03-31","2022-02-15","2022-01-27","2022-03-01","2022-02-06","2022-02-14","2022-01-27","2022-03-02","2022-03-02","2022-03-02","2022-02-01","2022-03-02","2022-02-14","2022-03-02","2022-02-01","2022-02-01","2022-03-02","2022-03-20","2022-02-01","2022-02-06","2022-03-20","2022-03-20","2022-01-31","2022-02-14","2022-02-01","2022-02-23","2022-02-01","2022-02-01","2022-03-02","2022-02-06","2022-02-06","2022-02-06","2022-02-23","2022-02-23","2022-02-14","2022-02-24","2022-02-23","2022-02-15","2022-02-23","2022-02-14","2022-02-14","2022-02-24","2022-02-15","2022-02-15","2022-02-14","2022-02-14","2022-02-14","2022-03-20","2022-03-01","2022-02-23","2022-02-23","2022-03-20","2022-02-23","2022-03-20","2022-03-01","2022-02-23","2022-03-01","2022-02-23","2022-02-23","2022-02-23","2022-02-23","2022-03-01","2022-02-23","2022-02-23","2022-02-23","2022-02-23","2022-02-23","2022-02-23","2022-02-24","2022-03-01","2022-03-01","2022-03-01","2022-03-02","2022-03-20","2022-03-02","2022-03-02","2022-03-02","2022-03-22","2022-03-22","2022-03-31","2022-03-20","2022-03-20","2022-03-31","2022-03-20","2022-03-20","2022-03-20","2022-03-20","2022-03-20","2022-03-20","2022-03-31","2022-03-22","2019-01-04","2019-01-04","2019-01-07","2019-01-07","2019-01-07","2019-01-11","2019-06-21","2019-06-03","2019-01-11","2019-01-11","2019-06-21","2019-01-11","2019-02-26","2019-01-11","2019-01-11","2019-02-26","2019-06-28","2019-06-28","2019-01-11","2019-05-18","2019-02-26","2019-03-22","2019-02-08","2019-03-22","2019-02-09","2019-02-16","2019-02-18","2019-02-18","2019-02-16","2019-02-18","2019-02-14","2019-02-14","2019-02-21","2019-02-14","2019-02-18","2019-02-16","2019-05-21","2019-02-21","2019-05-07","2019-02-21","2019-02-26","2019-02-26","2019-02-26","2019-03-22","2019-03-22","2019-03-22","2019-07-02","2019-03-22","2019-03-22","2019-03-22","2019-03-22","2019-03-22","2019-06-28","2019-05-07","2019-07-02","2019-06-28","2019-05-07","2019-05-07","2019-06-03","2019-05-07","2019-05-07","2019-05-10","2019-05-20","2019-05-15","2019-05-15","2019-05-20","2019-05-15","2019-05-20","2019-05-15","2019-06-21","2019-06-21","2019-05-16","2019-05-16","2019-06-28","2019-05-16","2019-05-16","2019-05-16","2019-07-02","2019-05-17","2019-06-03","2019-06-03","2019-06-28","2019-06-21","2019-06-21","2019-06-21","2019-06-28","2019-06-28","2019-07-02","2019-07-02","2019-07-02","2019-07-02","2019-07-02","2019-07-02","2019-07-02","2019-07-02","2019-07-02","2019-07-02","2019-07-07","2019-07-03","2019-07-03","2019-07-04","2019-07-07","2019-08-20"],"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":{"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":[["","68180012101","CEPHALEXIN","CAP 250MG","14","Select","Select",""],["","00093083205","CLONAZEPAM","TAB 0.5MG","60.00","Select","Select",""],["","70954002110","PRAZOSIN","CAP 5MG","60","Select","Select",""],["","59148003713","REXULTI","TAB 1MG","45","Select","Select",""],["","00093354656","ATOMOXETINE","CL 60 MG CAP","6","Select","Select",""],["","00093816501","QUETIAPINE","TAB 400MG","60","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","51991070510","ALPRAZOLAM","TAB 0.5MG","45","Select","Select",""],["","00093738301","VENLAFAXINE","TAB 100MG","60","Select","Select",""],["","69315013710","BENZTROPINE","TAB 1MG","30","Select","Select",""],["","42043032101","ESZOPICLONE","TAB 2MG","30","Select","Select",""],["","00185061501","HYDROXYZ","CAP 50MG","120","Select","Select",""],["","55111018010","TIZANIDINE","TAB 4MG","90","Select","Select",""],["","00173069700","ADVAIR","AER 500\/50","60","Select","Select",""],["","68462026001","VERAPAMIL","TAB 240MG ER","60","Select","Select",""],["","31722070430","VALACYCLOVIR","TAB 500MG","60","Select","Select",""],["","57664037718","TRAMADOL","TAB 50MG","30","Select","Select",""],["","59762444002","METHYLPRED","TAB 4MG","21","Select","Select",""],["","65862059501","DIVALPROEX","TAB 500MG ER","60.00","Select","Select",""],["","47781064610","LEVOTHYROXIN","TAB 75MCG","90","Select","Select",""],["","00143312610","DICYCLOMINE","CAP 10MG","240","Select","Select",""],["","50111064801","FLUOXETINE","CAP 20MG","60.00","Select","Select",""],["","69097012215","TOPIRAMATE","TAB 25MG","180","Select","Select",""],["","67405060403","FLUCONAZOLE","TAB 200MG","28","Select","Select",""],["","29300012510","MELOXICAM","TAB 15MG","30","Select","Select",""],["","43547039950","CYCLOBENZAPR","TAB 5MG","30","Select","Select",""],["","50228017705","GABAPENTIN","TAB 600MG","180","Select","Select",""],["","49483060350","IBUPROFEN","TAB 600MG","40","Select","Select",""],["","68180051902","LISINOP\/HCTZ","TAB 20-12.5","90","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","30","Select","Select",""],["","43386005019","GAVILYTE-N","SOL FLAV PK","8,000.00","Select","Select",""],["","59746017310","PREDNISONE","TAB 10MG","30","Select","Select",""],["","43386009019","GAVILYTE-G","SOL ","4,000.00","Select","Select",""],["","63304069205","CLINDAMYCIN","CAP 150MG","40","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","69230031203","ALLERGY","TAB 10MG","30","Select","Select",""],["","16729011917","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","66993058697","FLUTIC\/SALME","AER 500\/50","60","Select","Select",""],["","00143314205","DOXYCYCL","CAP 100MG","28","Select","Select",""],["","63824000850","MUCINEX","TAB 600MG ER","56","Select","Select",""],["","00496088230","LMX","CRE 0.04","5","Select","Select",""],["","60505530701","ACYCLOVIR","TAB 800MG","30","Select","Select",""],["","41167005820","ASPERCREME","CRE LIDOCAIN","76.5","Select","Select",""],["","45802008801","ALBUTEROL","AER HFA","8.5","Select","Select",""],["","67877019910","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","57237023305","SMZ-TMP","TAB 800-160","14","Select","Select",""],["","49502010202","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","24385030127","NAT","POW 0.4857","368","Select","Select",""],["","45802075930","PROMETHAZINE","SUP 25MG","5","Select","Select",""],["","68180016613","VANCOMYCIN","CAP 125MG","28","Select","Select",""],["","00115165201","METOCLOPRAM","TAB 5MG","25","Select","Select",""],["","59746012206","MECLIZINE","TAB 12.5MG","30","Select","Select",""],["","65862018730","ONDANSETRON","TAB 4MG","8","Select","Select",""],["","00904530680","BANOPHEN","CAP 25MG","30","Select","Select",""],["","68382018205","BUSPIRONE","TAB 15MG","18","Select","Select",""],["","00527135301","HYDROMORPHON","TAB 2MG","5","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","50383077504","LIDOCAINE","SOL 2% VISC","100","Select","Select",""],["","00781572005","POT  CL MICRO","TAB 20MEQ ER","30","Select","Select",""],["","57896048914","POLYETH","POW 3350 NF","238","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","40","Select","Select",""],["","57664037088","OXYCODONE","TAB 10MG","4","Select","Select",""],["","00536250676","SALINE","SPR 0.0065","44","Select","Select",""],["","00228212750","CLONIDINE","TAB 0.1MG","60","Select","Select",""],["","57896079101","SIMETHICONE","CHW 80MG","30","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":""}]}]}