{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CALLIE HARRIS","gend":1,"add":"1323 4TH STREET                                             ","city":"ALTAVISTA                     ","state":"VA","zip":"24517-1407","dob":"1995-08-25","age":"","mstatus":"","insh":10052289,"cliId":"","pno":4342213081,"cno":4342213081,"email":"","ename":"","eno":"","pphy":"GOFF, ELIZABETH GRACE                                       ","ppno":"","pcpadd":"1175 Corporate Park Dr,Ste E","pcpcity":"Forest                        ","pcpstate":"VA","pcpzip":245512238,"pcpcounty":"","pcpid":"P9307470","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"1323 4TH STREET                                             ","madd2":"                                                            ","madd3":"","mcity":"ALTAVISTA                     ","mstate":"VA","mzip":"24517-1407","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E78.2","Z01.419","E78.5","F17.218","B35.1","Z12.4","F17.200","F41.3","F41.9","R63.4","G47.00","F32.9","F33.1","Z23","R61","L70.0","Z72.0","Z87.891","R42","R11.0","Z30.9","K13.0","R11.2","R31.9","R19.7","Z68.1","G44.209","F19.239"],"date":["2021-11-03","2020-07-27","2019-07-24","2019-10-18","2020-04-27","2020-07-27","2019-10-18","2019-06-14","2021-11-03","2019-06-14","2019-06-14","2021-11-03","2020-02-19","2020-09-02","2020-11-13","2019-10-18","2021-09-10","2021-11-03","2020-10-13","2020-10-13","2020-11-13","2021-07-02","2021-09-10","2021-09-10","2021-09-10","2021-09-10","2021-10-22","2021-10-22"],"priorHcc":[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":[["","00603188016","LIDOCAINE","5%","30","Select","Select",""],["","16729020001","BUSPIRONE","5MG","60","Select","Select",""],["","00555902658","JUNEL","Jan-20","84","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","30","Select","Select",""],["","68462010530","ONDANSETRON","4MG","10","Select","Select",""],["","13668013601","ESCITALOPRAM","10MG","45","Select","Select",""],["","00555901658","SPRINTEC","28 DAY","84","Select","Select",""],["","00069046956","CHANTIX","1MG","56","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","30","Select","Select",""],["","00168020230","CLINDAMYCIN","1%","30","Select","Select",""],["","43547028810","BUPROPION","100MG SR","60","Select","Select",""],["","51672402606","KETOCONAZOLE","200MG","30","Select","Select",""],["","68462030929","NORGEST\/ETHI","0.25\/35","84","Select","Select",""],["","69097083412","SERTRALINE","50MG","30","Select","Select",""],["","00603188016","LIDOCAINE ","PAD 0.05","30","Select","Select",""],["","16729020001","BUSPIRONE ","TAB 5MG","60","Select","Select",""],["","00555902658","JUNEL ","TAB 43831","84","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","30","Select","Select",""],["","13668013601","ESCITALOPRAM ","TAB 10MG","45","Select","Select",""],["","68462030929","NORGEST\/ETHI ","TAB 0.25\/35","84","Select","Select",""],["","68462010530","ONDANSETRON ","TAB 4MG","10","Select","Select",""],["","00555901658","SPRINTEC ","TAB 28 DAY","84","Select","Select",""],["","00069046956","CHANTIX ","TAB 1MG","56","Select","Select",""],["","55111015810","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","62332049241","TIZANIDINE ","CAP 4MG","30","Select","Select",""],["","00168020230","CLINDAMYCIN ","GEL 0.01","30","Select","Select",""],["","00603254428","BUT\/APAP\/CAF ","TAB ","60","Select","Select",""],["","43547028810","BUPROPION ","TAB 100MG SR","60","Select","Select",""],["","51672402606","KETOCONAZOLE ","TAB 200MG","30","Select","Select",""],["","69097083412","SERTRALINE ","TAB 50MG","30","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","",""],["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":""}]}]}