{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WILLIAM F TYREE","gend":0,"add":"250 BANTON LANE","city":"GLADSTONE ","state":"VA","zip":"24553-9998","dob":"1946-08-19","age":"","mstatus":"","insh":11012361,"cliId":"8Y94XJ7TK86","pno":4349462635,"cno":4349073872,"email":"","ename":"","eno":"","pphy":"BROSE, TEODORA G","ppno":4343528235,"pcpadd":"131 Jones St, ","pcpcity":"Appomattox","pcpstate":"VA","pcpzip":245229830,"pcpcounty":"","pcpid":"P9307464","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"250 BANTON LANE ","madd2":"","madd3":"","mcity":"GLADSTONE ","mstate":"VA","mzip":"24553-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["I48.0","E03.9","J44.9","F41.1","E78.5","I48.91","Z85.038","Z90.49","I50.9","Z95.810","I12.9","N18.3","I47.2","Z79.899","Z79.01","J98.11","R91.8","R06.89","U07.1","J96.01","J12.89","I48.21","I42.9","J44.0","I13.0","I50.22","E87.1","N18.30","E86.1","R79.1","T45.515A","G47.33","N40.0","R06.02","R09.02","R06.2","I95.9","Z91.81","Z72.0","Z99.81","R00.2","I42.0","K64.9","I10","F41.9","Z76.0","N18.31","H26.492","H17.823","H26.491","J12.81","J96.91","Z87.438","N18.9","Z00.00","R30.0","B37.2"],"date":["2021-06-02","2021-07-02","2021-07-02","2021-07-02","2021-07-02","2021-09-22","2020-06-11","2020-06-11","2020-06-11","2021-02-09","2020-07-23","2020-07-23","2021-02-09","2021-02-09","2021-02-09","2020-10-17","2020-10-17","2020-10-17","2020-11-30","2020-11-27","2020-11-27","2020-11-27","2021-03-02","2020-10-17","2021-03-02","2020-11-27","2020-10-17","2020-11-27","2020-10-17","2020-10-17","2020-10-17","2020-11-27","2020-10-17","2020-10-17","2020-10-17","2020-10-17","2020-10-17","2020-11-27","2020-11-27","2020-11-27","2021-02-09","2021-02-09","2021-07-02","2021-07-02","2021-03-02","2020-11-30","2021-03-02","2021-04-02","2021-03-26","2021-04-09","2020-10-17","2020-10-17","2020-10-18","2020-10-17","2021-07-02","2021-07-02","2021-07-02"],"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":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}}]},{"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":[["","57237001401","TAMSULOSIN","CAP 0.4MG","","Select","Select",""],["","378020810","FUROSEMIDE","TAB 20MG","","Select","Select",""],["","378064110","PREDNISONE","TAB 10MG","","Select","Select",""],["","93317431","ALBUTEROL SUL","FAT E","","Select","Select",""],["","70377000911","ROSUVASTATIN","TAB 40MG","","Select","Select",""],["","310737020","BUDES\/FORMOT","AER 160-4.5","","Select","Select",""],["","49884030702","CLONAZEP ODT","TAB 0.25MG","","Select","Select",""],["","76385011250","CARVEDILOL","TAB 12.5MG","","Select","Select",""],["","93083205","CLONAZEPAM","TAB 0.5MG","","Select","Select",""],["","93172101","WARFARIN","TAB 5MG","","Select","Select",""],["","69452013217","DOFETILIDE","CAP 250MCG","","Select","Select",""],["","378180710","LEVOTHYROXIN","TAB 88MCG","","Select","Select",""],["","54327099","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","62559043130","HYDROCORTISO","CRE 0.025","","Select","Select",""],["","54418625","DEXAMETHASON","TAB 6MG","","Select","Select",""],["","378967130","IPRATROPIUM\/","SOL ALBUTER","","Select","Select",""],["","49281042050","FLUZONE QUAD","INJ 2020-21","","Select","Select",""],["","24208039915","IPRATROPIUM","SPR 0.0006","","Select","Select",""],["","173086910","ANORO ELLIPT","AER 62.5-25","","Select","Select",""],["","378064110","PREDNISONE ","TAB 10MG","30","Select","Select",""],["","24208039915","IPRATROPIUM ","SPR 0.0006","45","Select","Select",""],["","378020810","FUROSEMIDE ","TAB 20MG","90","Select","Select",""],["","57237001401","TAMSULOSIN ","CAP 0.4MG","90","Select","Select",""],["","49281042050","FLUZONE ","INJ 2020-21","0.5","Select","Select",""],["","378967130","IPRATROPIUM\/ ","SOL ALBUTER","360","Select","Select",""],["","76385011250","CARVEDILOL ","TAB 12.5MG","180","Select","Select",""],["","93317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","310737020","BUDES\/FORMOT ","AER 160-4.5","30.6","Select","Select",""],["","49884030702","CLONAZEP ","TAB 0.25MG","90","Select","Select",""],["","70377000911","ROSUVASTATIN ","TAB 40MG","90","Select","Select",""],["","62559043130","HYDROCORTISO ","CRE 0.025","30","Select","Select",""],["","93083205","CLONAZEPAM ","TAB 0.5MG","60","Select","Select",""],["","93172101","WARFARIN ","TAB 5MG","90","Select","Select",""],["","69452013217","DOFETILIDE ","CAP 250MCG","180","Select","Select",""],["","378180710","LEVOTHYROXIN ","TAB 88MCG","30","Select","Select",""],["","54327099","FLUTICASONE ","SPR 50MCG","48","Select","Select",""],["","173086910","ANORO ","62.5-25","60","Select","Select",""],["","54418625","DEXAMETHASON ","6MG","3","Select","Select",""],["","51672404801","CLOTRIM\/BETA ","DIPROP","15","Select","Select",""],["","59310057922","PROAIR ","","8.5","Select","Select",""],["","49884030702","CLONAZEP","0.25MG","90","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""],["","51672404801","CLOTRIM\/BETA","DIPROP","15","Select","Select",""],["","49281042050","FLUZONE","2020-21","0.5","Select","Select",""],["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","00173086910","ANORO","62.5-25","60","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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","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":""}]}]}