{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"IVORY JACKSON","gend":0,"add":"300   WYTHE STREET                                          ","city":"ALEXANDRIA                    ","state":"VA","zip":"22314-2036","dob":"1979-08-09","age":"","mstatus":"","insh":10043975,"cliId":"","pno":7033713196,"cno":7037984511,"email":"","ename":"","eno":"","pphy":"PETROS AYELE                                                ","ppno":"","pcpadd":"2146 Jefferson Davis Hwy","pcpcity":"STAFFORD                      ","pcpstate":"VA","pcpzip":225547223,"pcpcounty":"","pcpid":"P9307463","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"NORTHERN\/ WINCHESTER","aligned":"","ano":"","add2":"APT 415                                                     ","add3":"","madd1":"300   WYTHE STREET                                          ","madd2":"APT 415                                                     ","madd3":"","mcity":"ALEXANDRIA                    ","mstate":"VA","mzip":"22314-2036","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","K92.0","Z68.41","R07.89","I25.10","E66.01","E78.5","K76.0","E78.00","I86.4","R07.9","I20.0","R94.39","F10.120","Z79.899","F10.920","G89.29","Y90.8","R73.03","E11.9","R79.89","R06.02","R11.2","Z79.82","R07.81","R52","Z74.3","S39.012A","M54.5","X50.1XXA","Y99.0","Z82.49","X50.0XXA","M79.671","M79.2","N43.3","R10.30","R31.29","R68.89","R09.81","Z20.828","Z76.0","R06.00","M25.562","S83.422A","M79.605","M79.652","S76.312A","X58.XXXA","S86.912A","W01.0XXA","W20.8XXA","S89.92XA","R94.31","Z53.21"],"date":["2021-09-10","2019-02-24","2019-02-24","2021-09-10","2019-02-24","2020-08-28","2019-08-14","2019-02-24","2019-02-24","2019-02-24","2021-09-10","2019-03-01","2019-02-28","2019-05-20","2020-08-08","2019-05-20","2021-05-05","2019-05-20","2019-08-14","2021-09-10","2019-08-26","2019-09-25","2019-09-25","2021-09-10","2019-11-11","2021-01-12","2021-09-10","2019-11-11","2019-11-11","2020-09-08","2019-11-11","2021-05-05","2019-11-11","2020-03-31","2020-03-31","2020-04-03","2020-04-03","2020-04-03","2020-04-03","2020-08-25","2020-08-25","2020-08-28","2020-08-28","2021-05-05","2020-09-08","2020-10-13","2020-10-13","2020-10-13","2020-10-13","2020-11-15","2020-11-15","2021-05-05","2021-05-05","2021-08-16","2021-08-16"],"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":[["","64980043801","ATENOLOL","50MG","30","Select","Select",""],["","60505258009","ATORVASTATIN","40MG","30","Select","Select",""],["","43547035310","LISINOPRIL","10MG","30","Select","Select",""],["","67877019890","AMLODIPINE","5MG","30","Select","Select",""],["","67877032001","IBUPROFEN","600MG","21","Select","Select",""],["","57896010101","NON-ASPIRIN","325MG","24","Select","Select",""],["","00591352530","LIDOCAINE","5%","6","Select","Select",""],["","69315012710","FOLIC","1000MCG","90","Select","Select",""],["","00904671318","ASPIRIN","81MG EC","90","Select","Select",""],["","59762330401","NITROGLYCERN","0.4MG","100","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","65862085901","FAMOTIDINE","20MG","7","Select","Select",""],["","00904530660","BANOPHEN","25MG","10","Select","Select",""],["","57896022201","ACETAMINOPHE","500MG","30","Select","Select",""],["","69097085307","NAPROXEN","250MG","30","Select","Select",""],["","80777027399","MODERNA","COVID-19","0.5","Select","Select",""],["","21922000909","DICLOFENAC","1%","100","Select","Select",""],["","63824000832","MUCINEX","600MG ER","28","Select","Select",""],["","68382009301","CARVEDILOL","6.25MG","180","Select","Select",""],["","16729018301","HYDROCHLOROT","25MG","90","Select","Select",""],["","64980043801","ATENOLOL ","TAB 50MG","30","Select","Select",""],["","60505258009","ATORVASTATIN ","TAB 40MG","30","Select","Select",""],["","43547035310","LISINOPRIL ","TAB 10MG","30","Select","Select",""],["","67877019890","AMLODIPINE ","TAB 5MG","30","Select","Select",""],["","67877032001","IBUPROFEN ","TAB 600MG","21","Select","Select",""],["","57896010101","NON-ASPIRIN ","TAB 325MG","24","Select","Select",""],["","00591352530","LIDOCAINE ","PAD 0.05","6","Select","Select",""],["","68382009301","CARVEDILOL ","TAB 6.25MG","60","Select","Select",""],["","49483048112","ASPIRIN ","TAB 81MG EC","30","Select","Select",""],["","23155000801","HYDROCHLOROT ","TAB 25MG","30","Select","Select",""],["","69315012710","FOLIC ","TAB 1000MCG","90","Select","Select",""],["","59762330401","NITROGLYCERN ","SUB 0.4MG","100","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","7","Select","Select",""],["","00904530660","BANOPHEN ","CAP 25MG","10","Select","Select",""],["","57896022201","ACETAMINOPHE ","TAB 500MG","30","Select","Select",""],["","69097085307","NAPROXEN ","TAB 250MG","30","Select","Select",""],["","80777027399","MODERNA ","INJ COVID-19","0.5","Select","Select",""],["","21922000909","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","63824000832","MUCINEX ","TAB 600MG ER","28","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","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}