{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"FELICIA   A DICKERSON","gend":1,"add":"75   LUMBER  LANE                                           ","city":"BARBOURSVILLE                 ","state":"VA","zip":"22923-2703","dob":"1989-06-15","age":"","mstatus":"","insh":4211155,"cliId":"","pno":4342827055,"cno":2028483597,"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":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"75   LUMBER  LANE                                           ","add3":"","madd1":"75   LUMBER  LANE                                           ","madd2":"UNIT E                                                      ","madd3":"","mcity":"BARBOURSVILLE                 ","mstate":"VA","mzip":"22923-2703","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R05","J98.01","I10","J02.9","R11.0","R50.9","R63.0","M79.10","R00.0","Z85.41","Z87.891","J11.1","M25.572","M79.605","S86.812A","M79.662","W19.XXXA","S80.12XA","Z88.3","Z82.3","Z82.49","Z83.49","M79.641","M79.642","R07.9","R51","R06.02","R03.0","I11.9","R07.2","R00.2","R55","R87.619","Z11.3","Z01.419","Z12.4","Z11.51","R35.0","N39.0","R10.2","N93.8","G56.03","R53.83","Z23","J45.909","A69.20","F33.2","F43.10","F41.9","F41.0","M25.561","O34.80","Z3A.00","O99.341","Y90.3","W22.8XXA","Y92.410","O99.321","F10.139","R45.851","O16.1","F14.90","Z3A.01","F10.129","F17.200","O99.511","O34.81","F10.230","D72.829","O36.80X0","F43.9","O99.310","Z20.822","Z34.80","Z34.81","N89.8","F19.90","F32.9","Z98.890","O98.211","O98.219","Z36.87","F10.20","K59.00","Z3A.09","O9A.211","S06.0X0A","Z3A.10","W10.9XXA","Y93.9","Y92.9","M54.2","W10.8XXA","O26.891","Z13.79","Z36.3","Z3A.12","O10.919","Z31.5","O10.911","O34.41","Z34.82","Z39.1","Z34.83","O10.012","R51.9","O99.891","O26.892","Z3A.15","O16.2","R10.9","O09.891","O99.352","G44.229","Z3A.16","Z03.75","S06.0X0S","W34.00XA","O98.212","Z3A.18","Z3A.20","Z36.89","R20.0","O99.343","Z3A.23","O10.912","O99.342","O98.512","B00.9","F14.10","Z87.820","Z86.19","Z87.410","Z3A.26","W03.XXXA","Z3A.24","O9A.212","F32.1","Z3A.25","O16.3","Z3A.28","Z36.4","Z77.21","A74.9","Z3A.30","O26.893","O98.813","R10.11","N18.2","N18.9","D63.1","O10.913","Z3A.31","F32.A","O11.4","B00.2","O98.52","Z37.0","D64.9","O99.019","O99.42","O99.344","O99.52","O99.824","I51.7","O34.43","O11.3","Z3A.32","Z86.59","O99.613","K08.89","Z3A.33","O10.013","O14.13","O10.92","O43.893","O89.4","M25.531","M25.532","Z39.2","R09.81","R05.9","Z30.42","R30.0","B37.2","M25.50","Z00.00","N93.9","R10.30","K82.0","R10.31","R10.33"],"date":["2021-05-31","2020-01-13","2022-10-18","2020-02-12","2022-10-18","2020-02-12","2022-10-18","2020-02-12","2020-02-12","2022-10-18","2022-10-18","2020-02-12","2020-05-15","2020-06-09","2020-06-09","2020-06-09","2020-06-09","2020-06-09","2020-06-09","2020-06-09","2020-06-09","2020-06-09","2022-03-21","2022-03-21","2022-06-02","2020-08-17","2022-03-02","2020-08-17","2021-10-11","2020-09-11","2020-09-25","2020-09-25","2020-11-04","2022-08-02","2020-12-07","2020-12-07","2020-12-07","2020-12-18","2020-12-18","2022-08-02","2020-12-30","2021-06-11","2022-07-15","2021-11-30","2021-12-21","2021-04-27","2021-05-30","2021-05-30","2022-07-15","2021-05-29","2021-05-29","2021-05-29","2021-05-31","2021-05-31","2021-05-31","2021-05-29","2021-05-29","2021-05-29","2021-05-29","2021-05-29","2021-05-29","2021-05-29","2021-11-30","2021-05-29","2021-05-29","2021-05-29","2021-05-29","2021-05-30","2021-05-30","2021-05-30","2021-05-31","2021-05-31","2022-03-02","2021-06-25","2021-07-09","2021-06-11","2021-09-10","2021-10-12","2021-09-10","2021-08-27","2021-06-21","2021-06-25","2021-12-09","2021-07-09","2021-07-26","2021-07-16","2021-07-16","2021-07-16","2021-07-16","2021-07-16","2021-07-16","2021-07-16","2021-07-16","2021-07-16","2021-07-26","2021-09-20","2021-08-27","2021-10-27","2021-07-26","2021-08-27","2021-07-26","2021-11-16","2021-08-16","2021-11-30","2021-10-12","2021-08-19","2021-12-13","2021-10-20","2021-08-19","2021-08-19","2021-08-19","2021-08-27","2021-08-27","2021-08-27","2021-08-27","2021-08-27","2021-08-27","2021-09-10","2021-09-10","2021-09-20","2021-09-20","2021-09-20","2021-10-01","2021-12-13","2021-10-12","2021-10-20","2021-10-12","2021-10-11","2021-10-11","2021-10-11","2021-10-11","2021-10-11","2021-10-11","2021-10-19","2021-10-20","2021-10-20","2021-10-20","2021-10-27","2021-10-27","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-11-30","2021-12-02","2021-12-02","2021-11-30","2021-12-02","2021-12-02","2021-12-02","2021-12-02","2021-12-13","2021-12-07","2022-07-15","2021-12-21","2021-12-05","2021-12-05","2021-12-21","2021-12-05","2021-12-05","2021-12-21","2021-12-05","2021-12-21","2021-12-05","2021-12-21","2021-12-21","2021-12-13","2021-12-13","2021-12-13","2021-12-13","2021-12-13","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2021-12-24","2022-03-21","2022-03-21","2022-02-23","2022-03-02","2022-03-02","2022-10-19","2022-05-04","2022-05-10","2022-07-15","2022-07-15","2022-08-02","2022-08-02","2022-10-18","2022-10-18","2022-10-18"],"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":[["","70461032203","FLUCLVX","INJ 2022-23","0.5","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0.3","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","69097083412","SERTRALINE","TAB 50MG","90","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","76385011350","CARVEDILOL","TAB 25MG","30","Select","Select",""],["","50742062001","NIFEDIPINE","TAB 30MG ER","60","Select","Select",""],["","42806016005","HYDROXYZ","TAB 25MG","30","Select","Select",""],["","","ALBUTEROL","AER HFA","6.7","Select","Select",""],["","68462018135","CLOTRIMAZOLE","CRE 0.01","30","Select","Select",""],["","00093226301","AMOXICILLIN","TAB 500MG","21","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","31722070530","VALACYCLOVIR","TAB 1GM","32","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","45802091987","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","23155000810","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","00536440601","VITAMIN","TAB 25MG","30","Select","Select",""],["","59779006764","ANTIBIOTIC","OIN ","28.3","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","24658031205","DOXYCYCL","TAB 100MG","28","Select","Select",""],["","68180016011","AZITHROMYCIN","TAB 250MG","4","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","30","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","15","Select","Select",""],["","00603188016","LIDOCAINE","PAD 0.05","15","Select","Select",""],["","50428050854","CVS","PAK ","10","Select","Select",""],["","50428033343","BLOOD","KIT MANUAL","1","Select","Select",""],["","51672130406","TERCONAZOLE","CRE 0.004","45","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","49281042050","FLUZONE","INJ 2020-21","0.5","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","10","Select","Select",""],["","","BENZONATATE","CAP 100MG","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":""}]}]}