{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TONYA BERNARD","gend":1,"add":"672   LEESVILLE ROAD                                        ","city":"LYNCHBURG                     ","state":"VA","zip":"24502-2833","dob":"1974-06-11","age":"","mstatus":"","insh":10141684,"cliId":"","pno":4349442077,"cno":4349442077,"email":"","ename":"","eno":"","pphy":"EPPES, THOMAS W                                             ","ppno":4342003908,"pcpadd":"1175 Corporate Park Dr,Ste 101","pcpcity":"Forest                        ","pcpstate":"VA","pcpzip":245512238,"pcpcounty":"","pcpid":"P9307466","pcpname":"PRIVIA MEDICAL GROUP LLC","ano":"","add2":"                                                            ","add3":"","madd1":"672   LEESVILLE ROAD                                        ","madd2":"                                                            ","madd3":"","mcity":"LYNCHBURG                     ","mstate":"VA","mzip":"24502-2833","pcpfaxno":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R07.89","R06.02","R73.9","F17.210","Z86.59","Z82.49","J01.10","F22","R45.850","E66.01","F31.5","D75.1","Z68.43","J45.909","R03.0","E86.9","F41.9","Z79.899","Z91.419","R51","Z72.0","Z68.42","F31.4","F43.22","J01.90","F43.10","F60.5","R05","I10","Z23","Z20.828","J06.9","Z68.41","Z20.822","R45.851","N18.30","E87.1","G47.33","E87.6","I12.9","E78.5","F31.9","H04.123","R79.89","R25.1","R42","R20.0","R51.9","R20.2","N39.0","R06.4","K04.7","J30.89","J30.2","R09.82","R00.2","R06.00","F17.200","J02.9","J20.8","Z12.31","N64.4","R10.2","Z01.818","Z71.3","R92.8","N60.11","Z11.3","Z01.419","Z11.4","Z12.4","R87.610","Z11.51","R87.810","J01.40","U07.1","R07.9","Z53.21","J20.9","M25.571","M25.572","M79.89","R60.0","R05.9","F20.9","R44.3","F31.60","Z78.1","Z91.14"],"date":["2020-01-19","2021-10-19","2020-02-07","2021-11-05","2020-01-19","2021-05-20","2020-02-01","2021-11-25","2021-11-05","2021-07-20","2020-02-08","2020-02-06","2020-02-06","2021-11-08","2020-10-07","2020-02-06","2020-02-06","2021-03-15","2020-02-06","2020-02-06","2021-07-07","2021-07-20","2021-11-23","2020-03-04","2021-03-13","2020-09-14","2020-09-14","2021-09-28","2021-11-08","2021-01-26","2021-06-16","2021-07-24","2021-03-18","2021-11-05","2021-02-06","2021-10-19","2021-02-08","2021-09-13","2021-02-08","2021-10-19","2021-02-07","2021-02-07","2021-02-16","2021-02-26","2021-02-26","2021-02-25","2021-03-15","2021-09-17","2021-03-15","2021-03-18","2021-03-18","2021-04-02","2021-05-15","2021-05-15","2021-05-15","2021-05-20","2021-07-02","2021-05-20","2021-06-16","2021-06-16","2021-06-25","2021-07-09","2021-08-18","2021-07-16","2021-07-20","2021-07-28","2021-07-28","2021-08-18","2021-08-18","2021-08-18","2021-08-18","2021-08-18","2021-08-18","2021-08-18","2021-09-13","2021-09-17","2021-10-19","2021-05-10","2021-10-19","2021-10-19","2021-10-19","2021-10-19","2021-10-19","2021-10-19","2021-11-05","2021-11-05","2021-11-12","2021-11-08","2021-11-08"],"priorHcc":["","","",null,"","","",null,null,"","","","",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":[["","31722054501","LITHIUM","300MG","120","Select","Select",""],["","65862049301","QUETIAPINE","200MG","30","Select","Select",""],["","69238111906","BUSPIRONE","30MG","60","Select","Select",""],["","68180031906","BUPROPN","150MG XL","30","Select","Select",""],["","00093083205","CLONAZEPAM","0.5MG","35","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","63402030630","LATUDA","60MG","30","Select","Select",""],["","00169280015","SAXENDA","18MG\/3ML","15","Select","Select",""],["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","49483060450","IBUPROFEN","800MG","15","Select","Select",""],["","68180098003","LISINOPRIL","10MG","90","Select","Select",""],["","33342002208","LEVOFLOXACIN","500MG","10","Select","Select",""],["","65162068090","PROMETHAZINE","DM","140","Select","Select",""],["","58657070201","HALOPERIDOL","2MG","30","Select","Select",""],["","53746010901","HYDROCO\/APAP","5-325MG","8","Select","Select",""],["","08290320122","BD PEN NEEDL","32GX4MM","200","Select","Select",""],["","67877057305","BENZONATATE","100MG","30","Select","Select",""],["","71930002643","BROM\/PSE\/DM","","120","Select","Select",""],["","53489011905","DOXYCYCL","100MG","14","Select","Select",""],["","00093310905","AMOXICILLIN","500MG","21","Select","Select",""],["","00536589588","NICOTINE","14MG\/24H","14","Select","Select",""],["","51991081403","AZELASTINE","0.10%","30","Select","Select",""],["","00603533815","PREDNISONE","10MG","21","Select","Select",""],["","00135019401","NICODERM","21MG\/24H","21","Select","Select",""],["","24208039915","IPRATROPIUM","0.06%","15","Select","Select",""],["","65862057490","MONTELUKAST","10MG","30","Select","Select",""],["","59779044874","CVS","21MG\/24H","14","Select","Select",""],["","63304069205","CLINDAMYCIN","150MG","28","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","68180098003","LISINOPRIL ","TAB 10MG","90","Select","Select",""],["","71930002643","BROM\/PSE\/DM ","SYP ","120","Select","Select",""],["","16729028912","BUSPIRONE ","TAB 30MG","60","Select","Select",""],["","31722054501","LITHIUM ","CAP 300MG","120","Select","Select",""],["","65862049301","QUETIAPINE ","TAB 200MG","30","Select","Select",""],["","68180031906","BUPROPN ","TAB 150MG XL","30","Select","Select",""],["","00093083205","CLONAZEPAM ","TAB 0.5MG","35","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","63402030630","LATUDA ","TAB 60MG","30","Select","Select",""],["","00169280015","SAXENDA ","INJ 18MG\/3ML","15","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","49483060450","IBUPROFEN ","TAB 800MG","15","Select","Select",""],["","33342002208","LEVOFLOXACIN ","TAB 500MG","10","Select","Select",""],["","65162068090","PROMETHAZINE ","SOL DM","140","Select","Select",""],["","58657070201","HALOPERIDOL ","TAB 2MG","30","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","8","Select","Select",""],["","08290320122","BD  PEN NEEDL","MIS 32GX4MM","200","Select","Select",""],["","67877057305","BENZONATATE ","CAP 100MG","30","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","14","Select","Select",""],["","00093310905","AMOXICILLIN ","CAP 500MG","21","Select","Select",""],["","00536589588","NICOTINE ","DIS 14MG\/24H","14","Select","Select",""],["","51991081403","AZELASTINE ","SPR 0.001","30","Select","Select",""],["","00603533815","PREDNISONE ","PAK 10MG","21","Select","Select",""],["","00135019401","NICODERM ","DIS 21MG\/24H","21","Select","Select",""],["","24208039915","IPRATROPIUM ","SPR 0.0006","15","Select","Select",""],["","65862057490","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","59779044874","CVS ","DIS 21MG\/24H","14","Select","Select",""],["","63304069205","CLINDAMYCIN ","CAP 150MG","28","Select","Select",""],["","00116200116","CHLORHEX ","SOL 0.0012","473","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","",""],["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":""}]}]}