{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HAZEL L MITCHELL","gend":1,"add":"9 FORD ST","city":"LYNCHBURG","state":"VA","zip":"24501-9998","dob":"1937-12-10","age":"","mstatus":"","insh":11004943,"cliId":"8EN9M50YX37","pno":8044755277,"cno":4348511856,"email":"","ename":"","eno":"","pphy":"WADE, JAMES ","ppno":4349473944,"pcpadd":"2215 LANDOVER PLACE","pcpcity":"LYNCHBURG","pcpstate":"VA","pcpzip":245012115,"pcpcounty":"","pcpid":"P9120195","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"9303 Cason Road","add3":"","madd1":"9 FORD ST","madd2":"","madd3":"","mcity":"LYNCHBURG","mstate":"VA","mzip":"24501-9998","pcpfaxno":"                    ","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R69","R39.81","E11.9","M85.9","Z79.52","M06.9","B20","I10","E78.5","Z79.899","M85.88","M81.0","K21.9","J45.909","R01.1","R21","E55.9","J30.9","Z91.14","E78.00","Z00.00","Z85.3","Z21","R53.83","L30.9","L85.0","L20.9","N18.3","L29.9","R56.9","R27.9","G40.909","G40.409","R55","R06.02","R00.0","M85.852","M43.8X6","L28.1","L90.5","R41.0","Z23","H10.13","N18.30","Z01.00","G31.84","H02.403","K08.109","N39.41","R15.9","R26.81","R53.1","Z79.2","Z97.2","Z97.3","M85.80","B86","H25.13","H04.203","H01.001","H53.8","H52.4","K04.7","K08.89","K08.409"],"date":["2020-01-04","2020-02-08","2020-02-08","2020-01-23","2019-01-18","2019-01-18","2021-10-18","2020-12-18","2020-12-18","2020-12-15","2019-02-11","2020-11-06","2019-06-07","2020-12-18","2020-04-06","2019-03-04","2020-12-18","2019-03-04","2019-08-06","2019-03-04","2020-03-07","2020-12-18","2020-12-18","2020-03-11","2020-12-18","2019-03-27","2019-03-27","2020-08-07","2019-05-01","2019-09-04","2019-05-07","2019-05-19","2019-06-03","2019-10-01","2019-08-06","2019-08-06","2020-08-12","2020-08-12","2019-09-04","2019-09-04","2019-09-23","2019-10-24","2020-12-18","2020-12-18","2020-12-18","2018-11-19","2018-11-19","2018-11-19","2018-11-19","2018-11-19","2018-11-19","2018-11-19","2018-11-19","2018-11-19","2018-11-19","2020-12-15","2018-12-20","2021-06-16","2021-06-16","2021-06-16","2021-06-16","2021-06-16","2021-09-22","2021-09-22","2021-09-22"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","55111046605","METOPROL ","TAB 25MG ER","28","Select","Select",""],["","16729011917","MONTELUKAST ","TAB 10MG","28","Select","Select",""],["","69097082112","GEMFIBROZIL ","TAB 600MG","56","Select","Select",""],["","69097022476","ALENDRONATE ","TAB 70MG","4","Select","Select",""],["","68462042121","ATOVAQUONE ","SUS 750\/5ML","280","Select","Select",""],["","47781053272","FLUOCINONIDE ","CRE E 0.05%","120","Select","Select",""],["","68180016206","AZITHROMYCIN ","TAB 600MG","8","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","30","Select","Select",""],["","49702023113","TRIUMEQ ","TAB ","30","Select","Select",""],["","59762040906","ATAZANAVIR ","CAP 200MG","60","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","12","Select","Select",""],["","57237023305","SMZ-TMP ","TAB 800-160","12","Select","Select",""],["","168016315","CLOBETASOL ","CRE 0.0005","30","Select","Select",""],["","93317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","61958200201","DESCOVY ","TAB 200\/25","30","Select","Select",""],["","59676057530","PREZCOBIX ","TAB 800-150","60","Select","Select",""],["","70461032003","FLUCLVX ","2020-21","0.5","Select","Select",""],["","69097082112","GEMFIBROZIL","600MG","56","Select","Select",""],["","55111046605","METOPROL","25MG ER","28","Select","Select",""],["","16729011917","MONTELUKAST","10MG","28","Select","Select",""],["","65862032904","ALENDRONATE","70MG","4","Select","Select",""],["","68462042121","ATOVAQUONE","750\/5ML","280","Select","Select",""],["","47781053272","FLUOCINONIDE","E 0.05%","120","Select","Select",""],["","68180016206","AZITHROMYCIN","600MG","8","Select","Select",""],["","65862085901","FAMOTIDINE","20MG","30","Select","Select",""],["","49702023113","TRIUMEQ","","30","Select","Select",""],["","59762040906","ATAZANAVIR","200MG","60","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","12","Select","Select",""],["","00168016315","CLOBETASOL","0.0005","30","Select","Select",""],["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","57237023305","SMZ-TMP","800-160","12","Select","Select",""],["","61958200201","DESCOVY","200\/25","30","Select","Select",""],["","59676057530","PREZCOBIX","800-150","60","Select","Select",""],["","70461032003","FLUCLVX","2020-21","0.5","Select","Select",""],["","00378415105","TRAMADOL","50MG","14","Select","Select",""],["","42571025201","CLINDAMYCIN","300MG","30","Select","Select",""],["","00378415105","TRAMADOL ","TAB 50MG","14","Select","Select",""],["","42571025201","CLINDAMYCIN ","CAP 300MG","30","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}