{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"STEPHANIE   B FOSTER","gend":1,"add":"44   BIG HORN  DRIVE                                        ","city":"EVINGTON                      ","state":"VA","zip":"24550-2339","dob":"1957-08-20","age":"","mstatus":"","insh":10051692,"cliId":"","pno":4349428737,"cno":4349428737,"email":"","ename":"","eno":"","pphy":"PAULUS, DAVID R","ppno":"","pcpadd":"1088 London Links Dr","pcpcity":"Forest                        ","pcpstate":"VA","pcpzip":245514662,"pcpcounty":"","pcpid":"P9307467","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"44   BIG HORN  DRIVE                                        ","madd2":"                                                            ","madd3":"","mcity":"EVINGTON                      ","mstate":"VA","mzip":"24550-2339","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.5","Z96.651","Z78.9","J44.1","E78.5","G89.29","Z86.59","Z01.89","Z13.29","Z13.0","Z13.228","Z13.220","Z13.21","M79.604","Z79.891","I10","M79.10","K21.9","J30.89","R10.11","K83.8","E55.9","L02.412","K52.9","I42.9","M79.7","E11.9","F17.210","R10.30","N28.1","R10.9","I70.0","Z98.1","N39.3","M96.1","M25.561","M54.50","M25.512"],"date":["2021-09-15","2020-03-25","2021-11-23","2019-02-27","2020-10-22","2020-11-18","2019-02-27","2019-03-11","2019-03-11","2019-03-11","2019-03-11","2019-03-11","2019-03-11","2021-06-18","2021-01-19","2021-05-06","2019-06-03","2020-09-18","2020-06-23","2019-06-13","2019-06-13","2020-06-23","2020-06-23","2020-10-22","2020-10-22","2020-10-22","2020-10-22","2020-10-22","2020-10-22","2020-10-22","2020-10-22","2020-10-22","2020-10-22","2021-05-06","2021-05-03","2021-07-30","2021-11-23","2021-11-23"],"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":[]},{"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":[["","00591565810","CYCLOBENZAPR","10MG","90","Select","Select",""],["","69452015120","VITAMIN","50000UNT","4","Select","Select",""],["","49483060450","IBUPROFEN","800MG","270","Select","Select",""],["","42858080201","MORPHINE","30MG ER","60","Select","Select",""],["","65597030210","MORPHABOND","30MG ER","60","Select","Select",""],["","65162052111","PROMETHAZINE","25MG","120","Select","Select",""],["","45802065078","LORATADINE","10MG","90","Select","Select",""],["","68180072103","AMLODIPINE","10MG","90","Select","Select",""],["","62175061743","PANTOPRAZOLE","40MG","30","Select","Select",""],["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","50428536722","HEARTBRN","200MG","60","Select","Select",""],["","60505265701","TRIAMT\/HCTZ","75-50MG","30","Select","Select",""],["","10702005701","OXYCODONE","20MG","120","Select","Select",""],["","57237007630","ONDANSETRON","8MG","90","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","65862007701","CIPROFLOXACN","500MG","14","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","21","Select","Select",""],["","00591565810","CYCLOBENZAPR ","TAB 10MG","90","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","49483060450","IBUPROFEN ","TAB 800MG","270","Select","Select",""],["","42858080201","MORPHINE ","TAB 30MG ER","60","Select","Select",""],["","65597030210","MORPHABOND ","TAB 30MG ER","60","Select","Select",""],["","65162052111","PROMETHAZINE ","TAB 25MG","120","Select","Select",""],["","45802065078","LORATADINE ","TAB 10MG","90","Select","Select",""],["","68180072103","AMLODIPINE ","TAB 10MG","90","Select","Select",""],["","62175061743","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","50428536722","HEARTBRN ","TAB 200MG","60","Select","Select",""],["","60505265701","TRIAMT\/HCTZ ","TAB 75-50MG","30","Select","Select",""],["","10702005701","OXYCODONE ","TAB 20MG","120","Select","Select",""],["","57237007630","ONDANSETRON ","TAB 8MG","90","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","14","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","21","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","",""],["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":""}]}]}