{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TIFFANY JAMES","gend":1,"add":"137 OAK HILL DRIVE                                          ","city":"LYNCHBURG                     ","state":"VA","zip":"24502-3863","dob":"1981-09-07","age":"","mstatus":"","insh":10229333,"cliId":"","pno":4346654184,"cno":4346654184,"email":"","ename":"","eno":"","pphy":"COMBS, KIMBERLY H                                           ","ppno":5405351029,"pcpadd":"2019 Tate Springs Rd Ste A","pcpcity":"Lynchburg                     ","pcpstate":"VA","pcpzip":245011131,"pcpcounty":"","pcpid":"P9307474","pcpname":"PRIVIA MEDICAL GROUP LLC","ano":"","add2":"APT D                                                       ","add3":"","madd1":"137 OAK HILL DRIVE                                          ","madd2":"APT D                                                       ","madd3":"","mcity":"LYNCHBURG                     ","mstate":"VA","mzip":"24502-3863","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":["S82.61XB","S82.61XD","M25.571","D50.9","Z72.0","E11.9","F33.1","E78.5","K21.9","E66.9","E55.9","J45.909","R12","Z80.0","Z71.9","B37.9","E11.21","K31.89","K44.9","E78.00","K31.9","Z23","R00.0","R42","Z87.891","B37.3","I10","N92.0","M54.9","D64.9","F41.1","M79.672","N91.2"],"date":["2020-02-24","2020-05-11","2020-05-11","2021-08-09","2020-09-29","2021-11-05","2021-04-21","2020-09-29","2020-08-26","2020-10-26","2020-07-24","2020-07-24","2020-09-16","2020-08-24","2020-08-24","2020-08-26","2020-08-26","2020-09-16","2020-09-16","2020-09-16","2020-09-16","2021-11-05","2021-01-29","2021-01-29","2021-01-29","2021-01-29","2021-11-05","2021-05-14","2021-01-29","2021-11-05","2021-11-05","2021-08-09","2021-11-05"],"priorHcc":["","","","","",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":[["","68180051201","LISINOPRIL","2.5MG","90","Select","Select",""],["","10572010101","PEG-3350","ELECTROL","4,000.00","Select","Select",""],["","00169406013","VICTOZA","18MG\/3ML","9","Select","Select",""],["","69097083512","SERTRALINE","100MG","60","Select","Select",""],["","68180063709","ATORVASTATIN","40MG","90","Select","Select",""],["","33332032001","AFLURIA","2020-21","0.5","Select","Select",""],["","68462010340","FLUCONAZOLE","150MG","1","Select","Select",""],["","00904759180","FEROSUL","325MG","90","Select","Select",""],["","68645030059","METFORMIN","1000MG","180","Select","Select",""],["","00904759160","FERROUS","325MG","30","Select","Select",""],["","00069047103","CHANTIX","0.5& 1MG","53","Select","Select",""],["","50458014030","INVOKANA","100MG","90","Select","Select",""],["","70436001006","BUPROPN","150MG XL","30","Select","Select",""],["","52268001201","SUPREP","PREP KIT","354","Select","Select",""],["","68180051201","LISINOPRIL ","TAB 2.5MG","90","Select","Select",""],["","10572010101","PEG-3350 ","SOL ELECTROL","4,000.00","Select","Select",""],["","70436001102","BUPROPN ","TAB 300MG XL","30","Select","Select",""],["","00169406013","VICTOZA ","INJ 18MG\/3ML","9","Select","Select",""],["","69097083512","SERTRALINE ","TAB 100MG","60","Select","Select",""],["","68180063709","ATORVASTATIN ","TAB 40MG","90","Select","Select",""],["","33332032001","AFLURIA ","INJ 2020-21","0.5","Select","Select",""],["","68462010340","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","68645030059","METFORMIN ","TAB 1000MG","60","Select","Select",""],["","00904759180","FEROSUL ","TAB 325MG","90","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","00904759160","FERROUS ","TAB 325MG","30","Select","Select",""],["","00069047103","CHANTIX ","PAK 0.5& 1MG","53","Select","Select",""],["","50458014030","INVOKANA ","TAB 100MG","90","Select","Select",""],["","52268001201","SUPREP ","SOL PREP KIT","354","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":""}]}]}