{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ASHLEY   E STRATTON","gend":1,"add":"420 WADSWORTH STREET","city":"LYNCHBURG                     ","state":"VA","zip":"24501-9998","dob":"1991-07-08","age":"","mstatus":"","insh":4531198,"cliId":"","pno":4344773448,"cno":"","email":"","ename":"","eno":"","pphy":"COMBS, KIMBERLY H","ppno":4348467374,"pcpadd":"2019 Tate Springs Rd Ste A,","pcpcity":"Lynchburg                     ","pcpstate":"VA","pcpzip":245011131,"pcpcounty":"","pcpid":"","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"420 WADSWORTH STREET","add3":"","madd1":"420 WADSWORTH STREET","madd2":"APT 12","madd3":"","mcity":"LYNCHBURG                     ","mstate":"VA","mzip":"24501-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.11","F25.0","N60.19","F23","F48.9","F19.10","F31.9","F43.10","Z20.828","Z79.899","F17.210","F25.9","K50.90","F15.20","F14.20","R56.9","F90.9","R63.4","R45.850","Z91.14","Z56.0","Z90.49","Z91.040","Z88.1","R68.89","R51.9","S09.90XA","S10.93XA","S90.31XA","S99.921A","L02.612","B96.89","E03.9","Z23","M79.89","M60.071","Z00.01","T74.21XA","R52","R60.9","M25.561","S29.9XXA","S89.91XA","S79.921A","S99.922A","S80.02XA","R07.0","S90.32XA","S20.211A","M25.562","M79.672","R07.81","Y04.0XXA","Y92.89","Y93.89","S80.11XA","J40","R05","F41.9","B37.3","M79.642","S62.307A","S60.222A","S05.12XA","Z88.8","Y04.8XXA","S62.367A","S69.92XA","S91.331A","L02.412","W22.8XXA","R50.9","R41.82","U07.1","R11.2","R20.2","R11.0","R53.1","F11.20","F15.10","F43.12","F31.13","J02.9","F31.12","F29","I10","R45.851","F31.4","G47.00","K58.9","G43.909","F10.21","F11.10","F12.20","Z91.5","Z81.4","F12.90","Z87.891","F15.94","Y07.03","Y08.89XA","N39.0","F12.159","F13.159","F60.0","S02.2XXA","Z81.8","T76.21XA","E86.0","E87.6","T76.11XA","J34.2","S19.9XXA","F15.959","T74.91XA"],"date":["2021-02-26","2020-10-30","2020-10-20","2020-10-24","2020-10-24","2020-10-24","2020-11-26","2020-10-25","2020-10-24","2021-08-25","2021-08-25","2020-10-25","2020-10-25","2021-04-12","2020-10-25","2022-02-04","2020-10-25","2020-10-25","2020-10-25","2020-10-25","2020-10-25","2020-10-25","2021-08-25","2020-11-26","2020-10-30","2022-02-04","2021-08-25","2020-11-19","2020-11-19","2021-10-07","2020-11-26","2020-11-26","2021-08-25","2021-08-16","2020-11-26","2020-11-26","2021-04-08","2021-05-23","2021-06-28","2021-06-28","2021-06-28","2021-06-28","2021-06-28","2021-06-28","2021-06-28","2021-06-28","2021-06-28","2021-06-28","2021-06-28","2021-06-28","2021-06-28","2021-06-28","2021-06-28","2021-08-25","2021-06-28","2021-06-28","2021-08-16","2021-08-16","2021-08-16","2021-08-16","2021-08-25","2021-08-25","2021-08-25","2021-08-25","2021-08-25","2021-08-25","2021-08-25","2021-08-25","2021-10-06","2021-10-06","2021-10-06","2021-10-06","2022-02-04","2022-02-04","2022-02-04","2022-02-04","2022-02-04","2022-02-04","2022-03-10","2022-03-21","2022-03-10","2019-12-04","2019-04-23","2019-12-24","2019-12-24","2019-09-20","2019-09-20","2019-09-23","2019-09-20","2019-09-20","2019-09-20","2019-09-20","2019-09-20","2019-09-20","2019-09-20","2019-09-20","2019-09-20","2019-09-20","2019-12-24","2019-12-24","2019-12-24","2019-12-24","2019-12-24","2019-12-24","2019-12-24","2019-12-24","2019-12-24","2019-12-24","2019-12-24","2019-12-24","2019-12-24","2019-12-24","2019-12-24","2019-12-31","2019-12-31"],"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":[["","00078051005","TEGRETOL-XR","TAB 100MG","30.00","Select","Select",""],["","00093100301","BUSPIRONE","TAB 15MG","60","Select","Select",""],["","16729014801","QUETIAPINE","TAB 200MG","30","Select","Select",""],["","55111025960","ZIPRASIDONE","CAP 80MG","30","Select","Select",""],["","65862001205","SERTRALINE","TAB 50MG","30.00","Select","Select",""],["","10702001150","HYDROXYZ","TAB 25MG","120","Select","Select",""],["","42571016201","AMOX\/K","TAB 875-125","14","Select","Select",""],["","62559099212","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","62332042731","BENZONATATE","CAP 200MG","30","Select","Select",""],["","60432060416","PROMETHAZINE","SYP DM","140","Select","Select",""],["","16729013616","CLONAZEPAM","TAB 0.5MG","60","Select","Select",""],["","60505265301","TRAZODONE","TAB 50MG","30","Select","Select",""],["","61314062810","POLYMYXIN","SOL TRIMETHP","10","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","65862023060","LAMOTRIGINE","TAB 200MG","30","Select","Select",""],["","51672401106","CLOMIPRAMINE","CAP 25MG","60","Select","Select",""],["","63402030430","LATUDA","TAB 40MG","15","Select","Select",""],["","13668000805","ZOLPIDEM","TAB 10MG","7","Select","Select",""],["","66993068330","OLANZAPINE","TAB 10MG","30","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","20","Select","Select",""],["","00591215990","CICLOPIROX","SHA 0.01","120","Select","Select",""],["","13668001005","CITALOPRAM","TAB 20MG","7","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","51672127304","FLUOCINONIDE","SOL 0.0005","60","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":""}]}]}