{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JESSICA CAVIN","gend":1,"add":"518 JEFFERSON MANOR DRIVE                                   ","city":"FOREST                        ","state":"VA","zip":"24551-4063","dob":"1989-03-06","age":"","mstatus":"","insh":10122723,"cliId":"","pno":4343829991,"cno":8043388734,"email":"","ename":"","eno":"","pphy":"COMBS, KIMBERLY H                                           ","ppno":"","pcpadd":"2019 Tate Springs Rd Ste A,Ste 208","pcpcity":"Lynchburg                     ","pcpstate":"VA","pcpzip":245011131,"pcpcounty":"","pcpid":"P9307474","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"11112 VERDON RD                                             ","add3":"","madd1":"518 JEFFERSON MANOR DRIVE                                   ","madd2":"11112 VERDON RD                                             ","madd3":"","mcity":"FOREST                        ","mstate":"VA","mzip":"24551-4063","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S93.601A","S93.411A","M79.672","S93.409A","T14.8XXA","E10.65","E10.9","J30.9","H66.90","E10.3293","M25.561","G89.29","Z84.0","Z82.61","M79.10","M25.50","Z78.9","F33.1","F41.9","R45.4","R09.81","J01.90","G93.5","M54.2","R42","R51","M47.812","M25.512","M25.511","M50.30","M50.222","M79.641","G56.01","R45.851","Z20.828","E11.9","Z79.4","Z79.899","M19.90","F17.210","E78.00","Z23","Z88.5","Z91.410","Z63.9","F32.9","G89.4","Z72.0","Z09","F51.01","E28.2","G95.0","G56.03","L03.116","L02.416","S16.1XXA","W01.0XXA","S19.9XXA","E10.8","S81.802A","L08.9","J35.8","R51.9","M47.816","M54.5"],"date":["2019-01-12","2019-01-12","2019-01-12","2019-01-12","2019-01-12","2019-01-14","2021-10-18","2019-02-11","2019-02-24","2019-02-27","2019-06-14","2020-09-27","2019-06-14","2019-06-14","2019-06-14","2019-06-14","2019-06-14","2021-01-04","2021-01-04","2021-01-04","2019-09-16","2019-09-16","2020-12-28","2021-01-27","2020-06-11","2020-06-11","2020-12-13","2020-06-11","2020-06-11","2020-06-11","2020-12-21","2020-06-22","2020-12-28","2020-09-28","2020-09-27","2020-12-13","2020-12-01","2020-09-27","2020-09-28","2020-12-13","2020-09-27","2020-09-27","2020-09-27","2020-09-27","2020-09-27","2020-12-01","2020-09-28","2020-09-28","2020-10-01","2021-01-04","2021-01-04","2021-01-04","2021-01-27","2020-12-01","2020-12-01","2020-12-13","2020-12-13","2020-12-13","2020-12-28","2020-12-28","2021-01-04","2021-01-05","2021-01-05","2021-01-27","2021-01-27"],"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":[["","50228017705","GABAPENTIN","600MG","270","Select","Select",""],["","00093101042","MUPIROCIN","2%","22","Select","Select",""],["","00234057508","HIBICLENS","4%","236","Select","Select",""],["","68645058259","METFORMIN","500MG","30","Select","Select",""],["","57599080000","FREESTY","2 SENSOR","2","Select","Select",""],["","57599000101","FREESTYLE KIT SENSOR","SENSOR","2","Select","Select",""],["","65162019011","NAPROXEN","500MG","180","Select","Select",""],["","57599000200","FREESTYLE MIS READER","READER","1","Select","Select",""],["","00228203150","ALPRAZOLAM","1MG","30","Select","Select",""],["","50580072824","ZYRTEC-D","5-120MG","60","Select","Select",""],["","00088221905","LANTUS","100\/ML","15","Select","Select",""],["","61787044302","ZOSTRIX","0.10%","56","Select","Select",""],["","70700011485","LORYNA","3-0.02MG","84","Select","Select",""],["","37205064113","CAPSAICIN","0.10%","56","Select","Select",""],["","16714008210","HYDROXYZ","25MG","21","Select","Select",""],["","65162083366","DICLOFENAC","1%","200","Select","Select",""],["","50111056001","TRAZODONE","50MG","30","Select","Select",""],["","57237001930","DULOXETINE","60MG","30","Select","Select",""],["","65162027250","SMZ\/TMP","800-160","14","Select","Select",""],["","67877021905","CEPHALEXIN","500MG","21","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","47335071086","TOPIRAMATE","50MG","60","Select","Select",""],["","00169633910","NOVOLOG","FLEXPEN","30","Select","Select",""],["","78742043656","PRENATAL","","30","Select","Select",""],["","65862037405","ESCITALOPRAM","10MG","30","Select","Select",""],["","13668034030","LAMOTRIGINE","50MG ER","30","Select","Select",""],["","00143924920","AMOX\/K","875-125","20","Select","Select",""],["","68180044601","QUETIAPINE","50MG","30","Select","Select",""],["","70010077005","METHOCARBAM","750MG","28","Select","Select",""],["","55111014512","FLUCONAZOLE","150MG","2","Select","Select",""],["","00067611730","ALLERGY","10MG","30","Select","Select",""],["","45802065078","LORATADINE","10MG","30","Select","Select",""],["","08290320550","BD PEN NEEDL","32GX5\/32","400","Select","Select",""],["","99073070805","FREESTYLE MIS LITE","LITE","1","Select","Select",""],["","10702000709","CYCLOBENZAPR","10MG","30","Select","Select",""],["","99073013001","FREESTYLE MIS LANCETS","LANCETS","100","Select","Select",""],["","99073070822","FREESTYLE TES LITE","LITE","150","Select","Select",""],["","50228017705","GABAPENTIN ","TAB 600MG","270","Select","Select",""],["","00093101042","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","00234057508","HIBICLENS ","LIQ 0.04","236","Select","Select",""],["","68645058259","METFORMIN ","TAB 500MG","30","Select","Select",""],["","57599080000","FREESTY ","KIT 2 SENSOR","2","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","2","Select","Select",""],["","65162019011","NAPROXEN ","TAB 500MG","180","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","00228203150","ALPRAZOLAM ","TAB 1MG","30","Select","Select",""],["","50580072824","ZYRTEC-D ","TAB 5-120MG","60","Select","Select",""],["","00088221905","LANTUS ","INJ 100\/ML","15","Select","Select",""],["","61787044302","ZOSTRIX ","CRE 0.001","56","Select","Select",""],["","70700011485","LORYNA ","TAB 3-0.02MG","84","Select","Select",""],["","16714008210","HYDROXYZ ","TAB 25MG","120","Select","Select",""],["","37205064113","CAPSAICIN ","CRE 0.001","56","Select","Select",""],["","65162083366","DICLOFENAC ","GEL 0.01","200","Select","Select",""],["","50111056001","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","57237001930","DULOXETINE ","CAP 60MG","30","Select","Select",""],["","65162027250","SMZ\/TMP ","TAB 800-160","14","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","21","Select","Select",""],["","99073070822","FREESTYLE    TES LITE","TES LITE","150","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","47335071086","TOPIRAMATE ","TAB 50MG","60","Select","Select",""],["","00169633910","NOVOLOG ","INJ FLEXPEN","30","Select","Select",""],["","78742043656","PRENATAL ","TAB ","30","Select","Select",""],["","65862037405","ESCITALOPRAM ","TAB 10MG","30","Select","Select",""],["","13668034030","LAMOTRIGINE ","TAB 50MG ER","30","Select","Select",""],["","68180044601","QUETIAPINE ","TAB 50MG","30","Select","Select",""],["","00143924920","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","70010077005","METHOCARBAM ","TAB 750MG","28","Select","Select",""],["","55111014512","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","60505283303","ATOMOXETINE ","CAP 40MG","30","Select","Select",""],["","73070010315","INSULIN ","INJ FLEXPEN","30","Select","Select",""],["","00067611730","ALLERGY ","TAB 10MG","30","Select","Select",""],["","45802065078","LORATADINE ","TAB 10MG","30","Select","Select",""],["","08290320550","BD  PEN NEEDL","MIS 32GX5\/32","400","Select","Select",""],["","99073070805","FREESTYLE    MIS LITE","MIS LITE","1","Select","Select",""],["","10702000709","CYCLOBENZAPR ","TAB 10MG","30","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100","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","",""],["N\/A","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":""}]}]}