{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DONALD   L POWERS","gend":0,"add":"3666 SMITH MOUNTAIN LAKE PARKWAY","city":"HUDDLESTON","state":"VA","zip":"24104-3714","dob":"1971-01-26","age":"","mstatus":"","insh":"4735146","cliId":"","pno":"5402662941","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":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"3666 SMITH MOUNTAIN LAKE PARKWAY","madd2":"","madd3":"","mcity":"HUDDLESTON","mstate":"VA","mzip":"24104-3714","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K43.6","K43.2","I10","E03.9","J43.9","N40.0","K21.9","G89.29","B19.10","F32.9","M19.90","M50.30","Z88.5","Z87.442","F17.210","Z83.3","Z01.810","Z01.811","E78.5","M51.35","E55.9","Z79.891","K46.9","N40.1","M54.17","K92.1","R11.10","M54.5","M25.512","M54.2","Z71.3","M51.9","F17.200","F31.9","J44.9","K57.92","K58.9","Z13.89","D64.9","Z13.29","Z13.1","S61.209A","M79.89","S61.219A","M25.442","R03.0","E88.89","E72.12","M47.812","M47.816","M50.21","M41.9","Z13.0","R73.09","E53.8","R10.32","K57.32","Z90.89","Z90.49","E72.11","D52.0","D53.9","K59.00","R10.9","R16.1","R93.41","E61.1","E06.3","Z72.0","M46.44","M46.47","M46.42","M54.40","G95.9","M43.10","D50.9","M48.02","M50.221","M50.223","M54.6","Z12.5"],"date":["2020-01-10","2020-01-15","2022-01-20","2022-01-20","2020-01-10","2020-12-07","2021-03-03","2021-11-03","2020-01-10","2020-01-10","2020-09-25","2020-01-10","2020-01-10","2020-05-29","2021-03-03","2020-01-10","2020-01-10","2020-01-10","2022-01-20","2020-02-14","2022-01-20","2021-11-11","2020-01-15","2020-02-14","2020-03-13","2020-03-13","2020-03-13","2021-06-11","2020-03-18","2020-03-18","2020-04-19","2020-05-29","2020-05-29","2020-12-07","2020-05-29","2020-05-29","2020-05-29","2020-05-15","2021-09-23","2020-05-15","2020-09-25","2020-05-21","2020-05-19","2020-05-19","2020-05-19","2020-05-19","2020-06-08","2020-09-25","2020-06-08","2020-06-08","2020-06-08","2020-06-08","2020-09-25","2021-03-11","2020-09-25","2021-03-03","2020-12-07","2021-03-03","2020-12-07","2021-09-23","2021-09-23","2020-12-18","2021-03-03","2021-06-11","2021-03-03","2021-03-03","2021-09-23","2021-03-19","2021-06-11","2021-06-11","2021-06-11","2021-06-11","2021-11-03","2021-11-03","2021-11-03","2021-07-14","2021-10-22","2021-10-22","2021-10-22","2021-11-03","2022-01-20"],"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":[["","57664047758","METOPROL","TAB 50MG","180.00","Select","Select",""],["","00406851501","OXYCODONE","TAB 15MG","84.00","Select","Select",""],["","68462025401","ROPINIROLE","TAB 0.5MG","90.00","Select","Select",""],["","47781066210","LEVOTHYROXIN","TAB 150MCG","90.00","Select","Select",""],["","00603188016","LIDOCAINE","PAD 0.05","30.00","Select","Select",""],["","69097081507","GABAPENTIN","CAP 400MG","105.00","Select","Select",""],["","00378668910","PANTOPRAZOLE","TAB 40MG","90.00","Select","Select",""],["","69547035302","NARCAN","SPR ","2.00","Select","Select",""],["","59385002560","BELBUCA","MIS 600MCG","28.00","Select","Select",""],["","80681017000","VITAMIN","TAB 50MCG","30.00","Select","Select",""],["","65862059805","TAMSULOSIN","CAP 0.4MG","90.00","Select","Select",""],["","00591079501","DICYCLOMINE","TAB 20MG","84.00","Select","Select",""],["","31722000290","VENLAFAXINE","CAP 37.5 ER","60.00","Select","Select",""],["","67877024801","QUETIAPINE","TAB 400MG","30.00","Select","Select",""],["","16729004517","ATORVASTATIN","TAB 20MG","90.00","Select","Select",""],["","10702000350","PROMETHAZINE","TAB 25MG","30.00","Select","Select",""],["","50428016183","CVS","CAP 2000UNIT","30.00","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","90.00","Select","Select",""],["","65862050220","AMOX\/K","TAB 500-125","20.00","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","40.00","Select","Select",""],["","31604002665","FISH","CAP 1000MG","60.00","Select","Select",""],["","00904759180","FEROSUL","TAB 325MG","60.00","Select","Select",""],["","57237003105","AMOXICILLIN","CAP 500MG","21.00","Select","Select",""],["","64380074207","BUSPIRONE","TAB 10MG","90.00","Select","Select",""],["","43598044874","NICOTINE","DIS 21MG\/24H","14.00","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","28.00","Select","Select",""],["","62332001771","METRONIDAZOL","TAB 500MG","28.00","Select","Select",""],["","00000000000",""," ","300.00","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":""}]}]}