{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAMESA   E ANDERSON","gend":1,"add":"2255 COMMONWEALTH DR APT C","city":"CHARLOTTESVILLE","state":"VA","zip":"22901-9998","dob":"1983-01-24","age":"","mstatus":"","insh":"9507280*01","cliId":"","pno":"434\/409-8591","cno":"434\/409-8591","email":"","ename":"","eno":"","pphy":"GELBURD, GREGORY S DO","ppno":"434\/817-1818","pcpadd":"STE 9 310 AVON STREET","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22902,"pcpcounty":"","pcpid":210490,"pcpname":"Privia - Downtown Family Health Care, Inc","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/817-9606","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.31","R10.32","R07.9","M79.89","M94.0","I10.","Z71.3","Z71.89","R42.","R06.02","N30.01","Z11.59","G47.33","N84.0","D50.9","G62.9","R00.2","F41.9","F41.0","D50.0","Z13.220","Z23.","K44.9","K21.9","E66.01","Z68.43","Z09.","Z30.013","Z53.21","R20.0","R73.9","R20.2","N93.9","R10.2","Z30.011","R20.9","F32.9","R68.89","R09.89","F41.1","Z01.419","N39.0","Z20.2","R30.0","Z11.1","Z11.4","R00.0","Z30.09","R22.1","I51.7","R60.0","E78.5","E87.6","R79.1","I47.9","R55.","G44.209","R25.1","R53.83","M54.5","F41.8","N30.00","A64.","G44.82","H57.02","Z32.01","Z86.19","T14.8XXA","R07.89","H10.32","Z30.9"],"date":["2021-07-06","2020-01-15","2021-07-07","2020-05-07","2020-05-15","2021-05-04","2020-12-08","2020-12-08","2020-09-15","2021-06-02","2020-09-14","2020-09-14","2021-07-14","2020-12-15","2021-04-08","2020-12-15","2021-03-04","2021-08-28","2021-08-28","2020-08-03","2020-08-03","2021-08-12","2021-02-22","2021-07-07","2021-02-22","2021-02-22","2021-03-08","2021-03-08","2021-04-05","2020-02-06","2020-02-06","2021-02-11","2020-02-28","2020-02-28","2020-02-28","2020-09-14","2020-11-04","2021-01-04","2021-01-29","2021-06-18","2021-05-14","2021-05-14","2021-05-14","2021-07-06","2021-07-06","2021-07-06","2021-02-01","2021-03-01","2020-08-01","2020-08-01","2021-02-19","2021-02-19","2021-02-19","2020-05-08","2020-09-14","2020-09-14","2020-09-14","2020-09-14","2021-03-24","2021-05-04","2021-05-04","2021-05-04","2021-05-17","2020-09-15","2020-09-15","2021-02-22","2021-06-15","2021-07-22","2021-07-07","2021-07-30","2021-09-02"],"priorHcc":["","","","","","","","","","","","","","","","","","",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":[["","00378081005","HYDROCHLOROT ","12.5MG","30","Select","Select",""],["","45802057178","FEXOFENADINE ","180MG","30","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","00574050801","FERROUS ","324MG","180","Select","Select",""],["","59651000305","OMEPRAZOLE ","40MG","30","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","65162083366","DICLOFENAC ","1%","100","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","90","Select","Select",""],["","00067815203","VOLTAREN ","1%","100","Select","Select",""],["","16729020001","BUSPIRONE ","5MG","60","Select","Select",""],["","00245531911","KLOR-CON ","20MEQ ER","14","Select","Select",""],["","13668013601","ESCITALOPRAM ","10MG","90","Select","Select",""],["","53489011905","DOXYCYCL ","100MG","14","Select","Select",""],["","31722070190","LOSARTAN ","50MG","30","Select","Select",""],["","68462010530","ONDANSETRON ","4MG","20","Select","Select",""],["","50111064801","FLUOXETINE ","20MG","53","Select","Select",""],["","10702001150","HYDROXYZ ","25MG","60","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","10","Select","Select",""],["","13107008405","LORAZEPAM ","1MG","30","Select","Select",""],["","68180085211","MY ","1.5MG","1","Select","Select",""],["","69097083412","SERTRALINE ","50MG","30","Select","Select",""],["","00378064110","PREDNISONE ","10MG","10","Select","Select",""],["","47781030301","NITROFURANTN ","100MG","14","Select","Select",""],["","59762500801","MISOPROSTOL ","200MCG","4","Select","Select",""],["","49483060350","IBUPROFEN ","600MG","30","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","15","Select","Select",""],["","68180016113","AZITHROMYCIN ","500MG","6","Select","Select",""],["","00591565810","CYCLOBENZAPR ","10MG","21","Select","Select",""],["","24208031510","POLYMYXIN ","TRIMETHP","10","Select","Select",""],["","53746010901","HYDROCO\/APAP ","5-325MG","5","Select","Select",""],["","45802057178","FEXOFENADINE","180MG","30","Select","Select",""],["","00378081005","HYDROCHLOROT","12.5MG","30","Select","Select",""],["","00574050801","FERROUS","324MG","60","Select","Select",""],["","59651000305","OMEPRAZOLE","40MG","90","Select","Select",""],["","00254100752","ALBUTEROL","HFA","7","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","65162083366","DICLOFENAC","1%","100","Select","Select",""],["","00067815203","VOLTAREN","1%","100","Select","Select",""],["","50111064801","FLUOXETINE","20MG","53","Select","Select",""],["","10702001150","HYDROXYZ","25MG","60","Select","Select",""],["","68462010530","ONDANSETRON","4MG","20","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","10","Select","Select",""],["","16729020001","BUSPIRONE","5MG","60","Select","Select",""],["","68180072003","AMLODIPINE","5MG","90","Select","Select",""],["","31722070190","LOSARTAN","50MG","90","Select","Select",""],["","13668013601","ESCITALOPRAM","10MG","30","Select","Select",""],["","00245531911","KLOR-CON","20MEQ ER","14","Select","Select",""],["","69097083412","SERTRALINE","50MG","90","Select","Select",""],["","59762500801","MISOPROSTOL","200MCG","4","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","15","Select","Select",""],["","13107008405","LORAZEPAM","1MG","30","Select","Select",""],["","53489011905","DOXYCYCL","100MG","14","Select","Select",""],["","00591565810","CYCLOBENZAPR","10MG","21","Select","Select",""],["","49483060350","IBUPROFEN","600MG","30","Select","Select",""],["","68180016113","AZITHROMYCIN","500MG","6","Select","Select",""],["","24208031510","POLYMYXIN","TRIMETHP","10","Select","Select",""],["","53746010901","HYDROCO\/APAP","5-325MG","5","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","68180085211","MY","1.5MG","1","Select","Select",""],["","00378064110","PREDNISONE","10MG","10","Select","Select",""],["","47781030301","NITROFURANTN","100MG","14","Select","Select",""],["","24208039830","IPRATROPIUM ","SPR 0.0003","30","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","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":[[["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":""}]}]}