{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DOMINIQUE N GENTRY","gend":1,"add":"1508 LONGVIEW RD # 228  ","city":"LYNCHBURG","state":"VA","zip":"24501-6342","dob":"1986-10-06","age":"","mstatus":"","insh":11015913,"cliId":"2TM2RK2FN18","pno":7575036928,"cno":7572726412,"email":"","ename":"","eno":"","pphy":"CARMACK, JOHN F","ppno":4345346868,"pcpadd":"1175 Corporate Park Dr","pcpcity":"Forest","pcpstate":"VA","pcpzip":245512238,"pcpcounty":"","pcpid":"P9307464","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"Apt 101","add3":"","madd1":"1508 LONGVIEW RD # 228  ","madd2":"Apt 101","madd3":"","mcity":"LYNCHBURG","mstate":"VA","mzip":"24501-6342","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["N39.0","R45.7","F31.5","Z11.3","R14.3","N89.9","R06.89","R53.81","F43.10","R09.89","Y92.89","T42.6X6A","Z91.138","F19.10","D57.3","F31.9","F20.9","F17.210","Z79.899","Z76.0","F32.9","N76.0","R12","F12.10","R45.851","Z20.822","S79.911A","F15.14","F14.10","B00.9","F17.200","G47.00","N12","Z04.9","F31.70","F14.11","R10.13","A60.04","R14.0","K21.9","S19.9XXA","K59.00","R10.84","N83.209","E66.01","F41.9","F34.1","R10.9","K82.0","R30.0","R35.0","R39.89"],"date":["2021-04-11","2020-12-09","2021-11-09","2021-02-17","2021-02-27","2021-02-27","2020-11-25","2020-11-25","2021-09-10","2020-12-09","2020-12-09","2020-12-09","2020-12-09","2021-05-05","2021-05-23","2021-05-22","2021-05-23","2021-05-22","2021-08-19","2021-03-10","2021-08-19","2021-05-14","2021-05-14","2021-05-23","2021-05-23","2021-05-22","2021-05-22","2021-05-23","2021-05-23","2021-05-23","2021-05-23","2021-05-23","2021-05-14","2021-05-24","2021-06-09","2021-06-09","2021-06-15","2021-06-09","2021-06-15","2021-06-15","2021-05-22","2021-08-19","2021-08-19","2021-08-20","2021-08-19","2021-09-10","2021-09-10","2021-08-20","2021-08-20","2021-10-22","2021-10-22","2021-10-22"],"priorHcc":["","",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":[["","49483060350","IBUPROFEN","TAB 600MG","","Select","Select",""],["","31722070530","VALACYCLOVIR","TAB 1GM","","Select","Select",""],["","65862059501","DIVALPROEX","TAB 500MG ER","","Select","Select",""],["","43547030403","ARIPIPRAZOLE","TAB 10MG","","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","","Select","Select",""],["","31722070530","VALACYCLOVIR ","TAB 1GM","30","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","65862059501","DIVALPROEX ","TAB 500MG ER","90","Select","Select",""],["","49483060350","IBUPROFEN ","TAB 600MG","120","Select","Select",""],["","43547030403","ARIPIPRAZOLE ","TAB 10MG","30","Select","Select",""],["","55111015810","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","68180071160","CEFDINIR ","CAP 300MG","14","Select","Select",""],["","42806016105","HYDROXYZ ","50MG","30","Select","Select",""],["","50111056101","TRAZODONE ","100MG","30","Select","Select",""],["","50111033401","METRONIDAZOL ","500MG","14","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","1","Select","Select",""],["","50111056101","TRAZODONE","100MG","30","Select","Select",""],["","42806016105","HYDROXYZ","50MG","30","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","30","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","14","Select","Select",""],["","68180071160","CEFDINIR","300MG","14","Select","Select",""],["","00121087316","LACTULOSE","10GM\/15","300","Select","Select",""],["","00121087316","LACTULOSE ","SOL 10GM\/15","300","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","",""],["No","Select","","","","","Select","",""],["No","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":""}]}]}