{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHRISTINA   C HERNANDEZ","gend":1,"add":"3725 CAMPBELL AVENUE                                        ","city":"LYNCHBURG                     ","state":"VA","zip":"24501-4503","dob":"1989-10-04","age":"","mstatus":"","insh":10174834,"cliId":"","pno":4344268815,"cno":4344268815,"email":"","ename":"","eno":"","pphy":"BROSE, TEODORA G","ppno":"","pcpadd":"131 Jones St","pcpcity":"Appomattox                    ","pcpstate":"VA","pcpzip":245229830,"pcpcounty":"","pcpid":"P9307464","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"3013 Norma St                                               ","madd2":"                                                            ","madd3":"","mcity":"Lynchburg                     ","mstate":"VA","mzip":"24501-3615","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D18.03","R16.1","Z30.49","M54.5","F41.9","I10","Z79.891","F17.210","M25.531","F43.10","Z00.01","Z79.899","L60.0","M62.830","R11.0","J45.909","Z98.890","R10.9","F41.8","Z51.81","H57.89","H20.13","H44.113","Z91.030","R05.9","J02.9","J02.0","M25.571","M79.671","S93.421A","M54.9"],"date":["2020-04-03","2020-04-03","2021-07-13","2021-07-07","2020-04-06","2021-10-09","2021-11-16","2021-09-14","2020-07-30","2020-10-08","2020-08-11","2021-09-14","2021-09-14","2021-01-12","2021-01-12","2021-09-14","2021-01-12","2021-01-12","2021-03-09","2021-11-16","2021-08-06","2021-08-18","2021-08-18","2021-09-14","2021-10-09","2021-10-09","2021-10-09","2021-10-26","2021-10-26","2021-10-26","2021-11-16"],"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":[["","59762453701","MEDROXYPR","150MG\/ML","1","Select","Select",""],["","60758011905","PREDNISOLONE","1% OP","5","Select","Select",""],["","60505100301","KETOROLAC","0.50%","5","Select","Select",""],["","00832105415","BACLOFEN","10MG","60","Select","Select",""],["","43598075205","BUPROPION","150MG SR","30","Select","Select",""],["","13107000130","MIRTAZAPINE","7.5MG","30","Select","Select",""],["","70030013333","GOODSENSE","28-0.8MG","30","Select","Select",""],["","49884012301","LABETALOL","200MG","60","Select","Select",""],["","10370010150","BUPROPN","150MG XL","30","Select","Select",""],["","00093083205","CLONAZEPAM","0.5MG","60","Select","Select",""],["","00406012401","HYDROCO\/APAP","7.5-325","40","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","20","Select","Select",""],["","72205000390","ROSUVASTATIN","10MG","30","Select","Select",""],["","69097084507","CYCLOBENZAPR","5MG","21","Select","Select",""],["","50742062101","NIFEDIPINE","60MG ER","30","Select","Select",""],["","10702001801","OXYCODONE","5MG","20","Select","Select",""],["","69097015907","MELOXICAM","15MG","30","Select","Select",""],["","00074153903","HUMIRA","PS\/UV","3","Select","Select",""],["","00093081001","NORTRIPTYLIN","10MG","30","Select","Select",""],["","71093014105","METHOCARBAM","750MG","42","Select","Select",""],["","55111064534","OMEPRAZOLE","40MG","30","Select","Select",""],["","64380074206","BUSPIRONE","10MG","45","Select","Select",""],["","00054001729","PREDNISONE","10MG","15","Select","Select",""],["","59762453701","MEDROXYPR ","INJ 150MG\/ML","1","Select","Select",""],["","60758011905","PREDNISOLONE ","SUS 1% OP","5","Select","Select",""],["","60505100301","KETOROLAC ","SOL 0.005","5","Select","Select",""],["","00832105415","BACLOFEN ","TAB 10MG","60","Select","Select",""],["","43598075205","BUPROPION ","TAB 150MG SR","30","Select","Select",""],["","13107000130","MIRTAZAPINE ","TAB 7.5MG","30","Select","Select",""],["","49884012301","LABETALOL ","TAB 200MG","60","Select","Select",""],["","00904615760","VITAMIN ","TAB 2000UNIT","30","Select","Select",""],["","69097015907","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","00093310905","AMOXICILLIN ","CAP 500MG","20","Select","Select",""],["","70030013333","GOODSENSE ","TAB 28-0.8MG","30","Select","Select",""],["","10370010150","BUPROPN ","TAB 150MG XL","30","Select","Select",""],["","00093083205","CLONAZEPAM ","TAB 0.5MG","60","Select","Select",""],["","00406012401","HYDROCO\/APAP ","TAB 7.5-325","40","Select","Select",""],["","40985027111","D3 ","TAB 2000UNIT","30","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","20","Select","Select",""],["","72205000390","ROSUVASTATIN ","TAB 10MG","30","Select","Select",""],["","69097084507","CYCLOBENZAPR ","TAB 5MG","21","Select","Select",""],["","50742062101","NIFEDIPINE ","TAB 60MG ER","30","Select","Select",""],["","10702001801","OXYCODONE ","TAB 5MG","20","Select","Select",""],["","00074153903","HUMIRA ","KIT PS\/UV","3","Select","Select",""],["","16571020106","DICLOFENAC ","TAB 75MG DR","60","Select","Select",""],["","00093081001","NORTRIPTYLIN ","CAP 10MG","30","Select","Select",""],["","71093014105","METHOCARBAM ","TAB 750MG","42","Select","Select",""],["","55111064534","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","64380074206","BUSPIRONE ","TAB 10MG","45","Select","Select",""],["","00054001729","PREDNISONE ","TAB 10MG","15","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":""}]}]}