{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"STELLA   R HESTER","gend":1,"add":"2315   YORKTOWN  AVENUE                                     ","city":"LYNCHBURG                     ","state":"VA","zip":"24501-2154","dob":"1980-08-26","age":"","mstatus":"","insh":10222407,"cliId":"","pno":4344208478,"cno":4344208478,"email":"","ename":"","eno":"","pphy":"RAFFERTY, MOIRA                                             ","ppno":"","pcpadd":"2215 Landover Pl,Ste A","pcpcity":"Lynchburg                     ","pcpstate":"VA","pcpzip":245012115,"pcpcounty":"","pcpid":"P9120195","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"APT 700C                                                    ","add3":"","madd1":"2315   YORKTOWN  AVENUE                                     ","madd2":"APT 700C                                                    ","madd3":"","mcity":"LYNCHBURG                     ","mstate":"VA","mzip":"24501-2154","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M19.042","M25.50","M19.91","N62","L30.4","M54.89","M54.2","N60.22","N60.21","M54.9","E11.9","Z80.3","Z79.84","Z11.59","L98.7","F39","F43.10","M65.831","M79.631","M79.601","F41.1","F42.9","F90.2","F90.0"],"date":["2020-04-22","2020-04-22","2020-04-22","2020-06-02","2020-05-27","2020-05-27","2020-05-27","2020-05-27","2020-05-27","2020-05-27","2020-05-27","2020-05-27","2020-05-27","2020-05-27","2020-10-16","2021-11-11","2021-10-28","2021-06-14","2021-06-13","2021-06-13","2021-10-27","2021-10-27","2021-11-01","2021-11-11"],"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":[["","16729004417","ATORVASTATIN","10MG","30","Select","Select",""],["","71093013205","METFORMIN","500MG","60","Select","Select",""],["","68382066005","SPIRONOLACT","25MG","30","Select","Select",""],["","67877025001","QUETIAPINE","100MG","30","Select","Select",""],["","65162083366","DICLOFENAC","1%","100","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","30","Select","Select",""],["","43547040011","CYCLOBENZAPR","10MG","30","Select","Select",""],["","70954001910","PRAZOSIN","1MG","30","Select","Select",""],["","67405060301","FLUCONAZOLE","150MG","2","Select","Select",""],["","29300011101","LAMOTRIGINE","25MG","42","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","10702001101","HYDROXYZ","25MG","90","Select","Select",""],["","64764072030","TRINTELLIX","5MG","30","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","21","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","20","Select","Select",""],["","61874011530","VRAYLAR","1.5MG","30","Select","Select",""],["","16729004417","ATORVASTATIN ","TAB 10MG","30","Select","Select",""],["","71093013205","METFORMIN ","TAB 500MG","60","Select","Select",""],["","68382066005","SPIRONOLACT ","TAB 25MG","30","Select","Select",""],["","67877025001","QUETIAPINE ","TAB 100MG","30","Select","Select",""],["","64764075030","TRINTELLIX ","TAB 20MG","30","Select","Select",""],["","65162083366","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","55111015810","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","43547040011","CYCLOBENZAPR ","TAB 10MG","30","Select","Select",""],["","70954001910","PRAZOSIN ","CAP 1MG","30","Select","Select",""],["","67405060301","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","29300011101","LAMOTRIGINE ","TAB 25MG","42","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","10702001101","HYDROXYZ ","TAB 25MG","90","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","21","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","20","Select","Select",""],["","61874011530","VRAYLAR ","CAP 1.5MG","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":[[["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":""}]}]}