{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"FAYE   D WRIGHT-SPINKS","gend":1,"add":"399 BRYARLY ROAD                                            ","city":"WINCHESTER                    ","state":"VA","zip":"22603-4106","dob":"1970-04-24","age":"","mstatus":"","insh":10045994,"cliId":"","pno":5403271469,"cno":5403271469,"email":"","ename":"","eno":"","pphy":"GOPAL, MEENU ","ppno":"","pcpadd":"812 Amherst St","pcpcity":"Winchester                    ","pcpstate":"VA","pcpzip":226013344,"pcpcounty":"","pcpid":"P9348559","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"NORTHERN\/ WINCHESTER","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"399 BRYARLY ROAD                                            ","madd2":"                                                            ","madd3":"","mcity":"WINCHESTER                    ","mstate":"VA","mzip":"22603-4106","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C50.812","Z17.0","Z79.810","Z92.21","Z92.3","Z90.12","Z98.82","C50.912","M54.9","N95.1","R51","Z00.6","Z79.899","D64.9","M25.50","M25.571","M79.671","Z85.3","M79.89","K08.89","N63.20","R92.8","Z80.1","Z80.0","R10.11","R03.0","K80.20","Z01.419","R10.30","E03.9","R73.9","Z13.220","R31.9","Z12.31","I10","K21.9","M54.5","S62.101A","S60.211A","M25.531","M79.18","R10.9","V89.2XXA","R07.81","S20.212D","V89.2XXD","G47.9","R21","E87.6","T50.905A","L28.2","V89.2XXS","R23.8","S80.12XA","R22.42","Z20.822","J02.9","Z12.11","E66.01","R22.9","D12.6","D12.3","D12.4","N64.89","Z08","M47.816","M51.37","M51.36","M54.17","S90.32XA","W22.09XA","M43.16","R00.2","Z82.49","E78.1","E78.6","Z12.4","Z87.891","Z23","N90.9","B37.3","N76.89","N91.2"],"date":["2020-09-29","2021-10-21","2020-09-29","2020-12-23","2020-09-29","2021-05-11","2020-09-29","2021-10-21","2021-10-21","2021-10-21","2019-03-11","2021-04-20","2019-03-11","2019-04-22","2019-11-26","2019-03-26","2019-03-26","2021-11-24","2020-12-23","2019-05-09","2019-08-13","2019-08-13","2021-11-24","2021-11-24","2020-06-08","2020-02-24","2020-11-21","2019-09-24","2020-02-24","2021-02-17","2020-02-24","2020-02-24","2020-02-24","2021-11-24","2021-11-17","2021-10-21","2021-08-18","2020-11-07","2020-11-10","2020-11-10","2020-11-21","2020-11-21","2021-02-23","2021-02-23","2020-11-23","2020-11-23","2020-11-25","2020-11-30","2020-12-09","2020-12-09","2020-12-09","2020-12-09","2021-01-20","2020-12-23","2020-12-26","2021-01-04","2021-01-04","2021-02-17","2021-08-18","2021-03-03","2021-03-03","2021-02-17","2021-02-17","2021-05-11","2021-05-11","2021-07-21","2021-06-11","2021-06-11","2021-06-11","2021-06-21","2021-06-21","2021-07-15","2021-11-17","2021-11-17","2021-11-17","2021-08-18","2021-11-17","2021-08-18","2021-08-18","2021-09-15","2021-09-15","2021-10-21","2021-10-21"],"priorHcc":["","","","","","","","","","","","","","","","","",null,"","","","",null,null,"","","","","","","","","",null,null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,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":[]},{"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":[["","59651000305","OMEPRAZOLE","40MG","30","Select","Select",""],["","00591247330","TAMOXIFEN","20MG","90","Select","Select",""],["","65862020390","LOSARTAN","100MG","30","Select","Select",""],["","00093310905","AMOXICILLIN","500MG","21","Select","Select",""],["","59651036205","IBUPROFEN","800MG","28","Select","Select",""],["","69097015907","MELOXICAM","15MG","30","Select","Select",""],["","00536128128","LIDOCAINE","4%","120","Select","Select",""],["","00093005805","TRAMADOL","50MG","30","Select","Select",""],["","65162019050","NAPROXEN","500MG","28","Select","Select",""],["","68180030260","CEFUROXIME","250MG","10","Select","Select",""],["","70710145603","CLOBETASOL","0.05%","60","Select","Select",""],["","42806016005","HYDROXYZ","25MG","30","Select","Select",""],["","59267100001","PFIZER","COVID-19","0.3","Select","Select",""],["","51672128901","NYSTATIN","100000","15","Select","Select",""],["","45802071708","TERCONAZOLE","80MG","3","Select","Select",""],["","10702000710","CYCLOBENZAPR","10MG","90","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","20","Select","Select",""],["","53746010901","HYDROCO\/APAP","5-325MG","20","Select","Select",""],["","45802048678","DOCUSATE","100MG","60","Select","Select",""],["","59651000305","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","00591247330","TAMOXIFEN ","TAB 20MG","90","Select","Select",""],["","65862020390","LOSARTAN ","TAB 100MG","30","Select","Select",""],["","00093310905","AMOXICILLIN ","CAP 500MG","21","Select","Select",""],["","59651036205","IBUPROFEN ","TAB 800MG","28","Select","Select",""],["","69097015907","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","00536128128","LIDOCAINE ","CRE 0.04","120","Select","Select",""],["","00116200116","CHLORHEX ","SOL 0.0012","1,419.00","Select","Select",""],["","00093005805","TRAMADOL ","TAB 50MG","30","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","28","Select","Select",""],["","68180030260","CEFUROXIME ","TAB 250MG","10","Select","Select",""],["","70710145603","CLOBETASOL ","CRE 0.0005","60","Select","Select",""],["","42806016005","HYDROXYZ ","TAB 25MG","30","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","51672128901","NYSTATIN ","CRE 100000","15","Select","Select",""],["","45802071708","TERCONAZOLE ","SUP 80MG","3","Select","Select",""],["","10702000710","CYCLOBENZAPR ","TAB 10MG","90","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","14","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","20","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","20","Select","Select",""],["","45802048678","DOCUSATE ","CAP 100MG","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","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}