{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KATRINA CHILDRESS","gend":1,"add":"142 GREENWOOD DR  ","city":"MADISON HEIGHTS","state":"VA","zip":"24572-9998","dob":"1963-06-28","age":"","mstatus":"","insh":11014178,"cliId":"3PA7CM0RF53","pno":4343631890,"cno":4343637782,"email":"","ename":"","eno":"","pphy":"SWARTZ, DANIEL JONATHAN ","ppno":4342005200,"pcpadd":"2321 Wards Rd","pcpcity":"Lynchburg","pcpstate":"VA","pcpzip":245022101,"pcpcounty":"","pcpid":"P9120196","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"142 GREENWOOD DR  ","madd2":"","madd3":"","mcity":"MADISON HEIGHTS","mstate":"VA","mzip":"24572-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["R39.81","R31.9","L22","D68.52","Z51.81","Z86.718","Z79.01","I25.10","Z72.0","E11.65","E11.59","E11.69","E11.42","L98.1","L29.9","M62.830","R11.0","I10","B97.29","F42.4","Z95.9","I20.0","I95.9","M60.9","D68.2","I82.221","I65.29","E11.51","I73.9","Z79.4","E78.5","G47.33","Z79.02","Z79.84","F17.210","I82.90","I47.1","R10.9","R10.814","K65.4","R19.5","E11.9","I25.2","Z87.19","Z53.21","K59.00","M54.9","E11.3293","M30.0","H25.13","R09.89","J02.9","R05","J06.9","Z78.9","F41.1","B35.6","S86.912A","Z95.5","E66.3","Z87.891","Z87.01","R07.9","E11.3393","R19.7","R09.81","Z20.9","R68.89","R10.30","R15.9","F17.200","Z09","B37.3","E11.319","H43.10","I65.23","J45.909","G47.30","I49.9","K21.9","R13.10","M31.7","Z68.24","Z95.828","Z79.899","K59.09","F32.9","N39.46","M06.9","R21","H54.7","R30.0","Z03.818","Z20.828","I25.110","R07.89","I12.9","N18.9","Z82.49","E11.22","Z91.14","L73.9","Z20.822","Q99.8","I82.431","L02.91","L02.811","S11.90XA"],"date":["2021-11-16","2021-11-16","2021-11-16","2020-06-09","2020-06-09","2020-07-21","2021-08-24","2021-08-24","2021-08-24","2021-09-28","2021-09-28","2021-08-24","2021-02-16","2020-08-19","2020-06-09","2021-07-27","2021-09-03","2021-02-16","2020-07-01","2020-06-12","2020-09-29","2020-09-29","2020-09-29","2020-06-17","2021-01-02","2020-06-17","2021-08-24","2020-09-29","2020-09-29","2021-02-16","2021-01-02","2021-08-24","2020-06-17","2020-06-17","2020-06-28","2020-06-17","2020-06-17","2020-08-31","2020-06-28","2020-06-28","2020-06-28","2021-08-31","2020-07-21","2020-06-28","2020-06-28","2021-02-16","2020-12-23","2020-07-13","2021-09-17","2021-01-11","2020-09-29","2020-08-22","2021-01-02","2020-11-12","2021-09-27","2020-12-23","2020-09-08","2020-09-08","2021-08-24","2020-09-29","2021-08-24","2021-02-04","2021-01-02","2021-01-11","2021-02-04","2021-02-04","2021-02-04","2021-02-04","2021-02-16","2021-02-16","2021-02-16","2021-02-16","2021-02-16","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2021-07-27","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2021-01-02","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2020-12-23","2021-04-28","2021-04-28","2021-01-02","2021-01-02","2021-01-02","2021-01-02","2021-01-02","2021-01-02","2021-01-02","2021-10-12","2021-09-13","2021-08-24","2021-07-27","2021-09-13","2021-09-27","2021-09-28"],"priorHcc":[null,null,null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","43547028211","ESCITALOPRAM","TAB 20MG","","Select","Select",""],["","193658621","MICROLET","MIS LANCETS","","Select","Select",""],["","2143480","TRULICITY","INJ 1.5\/0.5","","Select","Select",""],["","832105415","BACLOFEN","TAB 10MG","","Select","Select",""],["","54327099","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","169255013","TRESIBA FLEX","INJ 200UNIT","","Select","Select",""],["","65862055990","PANTOPRAZOLE","TAB 20MG","","Select","Select",""],["","68645058259","METFORMIN","TAB 500MG","","Select","Select",""],["","55111015330","ONDANSETRON","TAB 4MG","","Select","Select",""],["","68645019059","METOPROL TAR","TAB 50MG","","Select","Select",""],["","169633910","NOVOLOG","INJ FLEXPEN","","Select","Select",""],["","8290320109","BD PEN NEEDL","MIS 31GX8MM","","Select","Select",""],["","193731150","CONTOUR","TES NEXT","","Select","Select",""],["","68645048154","ATORVASTATIN","TAB 20MG","","Select","Select",""],["","168020437","LIDOCAINE","OIN 0.05","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","60505464303","PRASUGREL","TAB 10MG","","Select","Select",""],["","51672129802","KETOCONAZOLE","CRE 0.02","","Select","Select",""],["","72205001390","PREGABALIN","CAP 75MG","","Select","Select",""],["","68462063945","NITROGLYCERN","SUB 0.4MG","","Select","Select",""],["","168002031","HYDROCORT","OIN 0.01","","Select","Select",""],["","86227012105","SURE COMFORT","MIS 31GX3\/16","","Select","Select",""],["","57237001830","DULOXETINE","CAP 30MG","","Select","Select",""],["","68382080510","TRAZODONE","TAB 50MG","","Select","Select",""],["","45802011222","MUPIROCIN","OIN 0.02","","Select","Select",""],["","50458058030","XARELTO","TAB 10MG","","Select","Select",""],["","8470115001","UNIFINE PNTP","MIS 31GX3\/16","","Select","Select",""],["","50228042360","RANOLAZINE","TAB 500MG ER","","Select","Select",""],["","93317431","ALBUTEROL SUL","FAT E","","Select","Select",""],["","54004641","IPRATROPIUM","SPR 0.0006","","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","","Select","Select",""],["","456120130","LINZESS","CAP 145MCG","","Select","Select",""],["","57599000200","FREESTYLE","MIS READER","","Select","Select",""],["","45802005535","TRIAMCINOLON","OIN 0.001","","Select","Select",""],["","2143480","TRULICITY ","INJ 1.5\/0.5","2","Select","Select",""],["","193658621","MICROLET ","MIS LANCETS","100","Select","Select",""],["","169255013","TRESIBA ","INJ 200UNIT","18","Select","Select",""],["","43547028211","ESCITALOPRAM ","TAB 20MG","30","Select","Select",""],["","832105415","BACLOFEN ","TAB 10MG","360","Select","Select",""],["","68645058259","METFORMIN ","TAB 500MG","120","Select","Select",""],["","54327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","43598043611","NITROGLYCERN ","SUB 0.4MG","25","Select","Select",""],["","55111015330","ONDANSETRON ","TAB 4MG","10","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","60505464303","PRASUGREL ","TAB 10MG","30","Select","Select",""],["","68645019059","METOPROL ","TAB 50MG","30","Select","Select",""],["","8290320109","BD  PEN NEEDL","MIS 31GX8MM","100","Select","Select",""],["","65862055990","PANTOPRAZOLE ","TAB 20MG","30","Select","Select",""],["","193731150","CONTOUR ","TES NEXT","100","Select","Select",""],["","168002031","HYDROCORT ","OIN 0.01","28.35","Select","Select",""],["","50111043301","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","169633910","NOVOLOG ","INJ FLEXPEN","15","Select","Select",""],["","68645048154","ATORVASTATIN ","TAB 20MG","30","Select","Select",""],["","50458058090","XARELTO ","TAB 10MG","90","Select","Select",""],["","86227013085","SURE ","MIS 32GX5\/32","100","Select","Select",""],["","72205001390","PREGABALIN ","CAP 75MG","90","Select","Select",""],["","57237001830","DULOXETINE ","CAP 30MG","30","Select","Select",""],["","68462018022","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","93317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","50228042360","RANOLAZINE ","TAB 500MG ER","60","Select","Select",""],["","168020437","LIDOCAINE ","OIN 0.05","35.44","Select","Select",""],["","45802005535","TRIAMCINOLON ","OIN 0.001","15","Select","Select",""],["","51672129802","KETOCONAZOLE ","CRE 0.02","30","Select","Select",""],["","8470115001","UNIFINE ","MIS 31GX3\/16","100","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","6","Select","Select",""],["","59746017509","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","54004641","IPRATROPIUM ","SPR 0.0006","15","Select","Select",""],["","456120130","LINZESS ","CAP 145MCG","30","Select","Select",""],["","65702015610","SOFTCLIX","LANCETS","100","Select","Select",""],["","57599000200","FREESTYLE MIS READER","READER","1","Select","Select",""],["","99073013001","FREESTYLE MIS LANCETS","LANCETS","100","Select","Select",""],["","57599157904","FREESTYLE TES PREC NEO","PREC NEO","50","Select","Select",""],["","56151014201","TRUEDRAW","LANC DEV","1","Select","Select",""],["","00169255013","TRESIBA","200UNIT","18","Select","Select",""],["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","68645019059","METOPROL","50MG","30","Select","Select",""],["","86227013085","SURE","32GX5\/32","100","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""],["","57599000101","FREESTYLE KIT SENSOR","SENSOR","2","Select","Select",""],["","08470115001","UNIFINE","31GX3\/16","100","Select","Select",""],["","65702015610","SOFTCLIX ","MIS LANCETS","100","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100","Select","Select",""],["","56151014201","TRUEDRAW ","MIS LANC DEV","1","Select","Select",""],["","57599157904","FREESTYLE    TES PREC NEO","TES PREC NEO","50","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","",""],["Yes","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":""}]}]}