{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" J EIBBOBNOSREDNEH","gend":1,"add":"         EIKSELAB HAROBED                         ","city":"FRONT ROYAL              ","state":"VA","zip":"22630-4621","dob":"1973-12-09","age":"","mstatus":"","insh":"00119385","cliId":"","pno":"0304555055","cno":5406359866,"email":"","ename":"","eno":"","pphy":"DUCK, ROBERT W","ppno":5407220220,"pcpadd":"812 AMHERST ST STE 101,  ","pcpcity":"Winchester","pcpstate":"VA","pcpzip":226013344,"pcpcounty":"","pcpid":"","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"1440   LOCUST STREET                              ","add3":"","madd1":"DEBORAH BALESKIE                                  ","madd2":"1440   LOCUST STREET                              ","madd3":"","mcity":"FRONT ROYAL              ","mstate":"VA","mzip":"22630-4621","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Q85.01","F41.9","G31.09","J45.909","M50.322","M47.812","I10","J41.0","Q85.00","J20.9","R06.02","R50.9","R05","R07.9","F03.90","Z00.00","M50.222","M43.02","F32.0","Z12.11","E78.00","E66.01","K29.70","J30.9","E24.9","R53.83","F32.9","R26.9","K76.0","Z68.41","J45.40","J44.9","M99.01","S13.160A","M54.2","R06.00","J10.1","D72.89","R03.0","H21.89","J42","R06.2","N39.46","N94.2","R35.1","Z12.4","J40","F41.1","F41.0","M62.81"],"date":["2022-05-25","2022-05-18","2022-05-18","2022-04-08","2022-05-25","2022-05-25","2022-05-20","2020-02-14","2020-02-14","2020-01-14","2019-01-22","2019-01-22","2020-01-14","2019-01-22","2022-04-08","2021-09-20","2022-05-25","2022-05-25","2022-04-08","2021-10-06","2021-09-20","2022-04-08","2019-04-04","2019-04-04","2019-04-04","2019-04-04","2020-01-31","2019-04-04","2019-04-04","2019-05-16","2020-01-31","2020-03-07","2020-01-02","2020-01-02","2020-01-02","2019-01-22","2019-01-22","2019-01-22","2019-01-22","2020-10-08","2019-05-16","2020-01-14","2019-05-01","2019-05-01","2019-05-01","2019-05-01","2019-08-14","2019-08-20","2019-08-20","2019-03-15"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","59310030480","QVAR","AER 80MCG","10.6","Select","Select",""],["","68180051802","LISINOP\/HCTZ","TAB 10-12.5","30","Select","Select",""],["","52427057630","FLUOXETINE","TAB 60MG","30","Select","Select",""],["","59310057922","PROAIR","AER ","8.5","Select","Select",""],["","00093317431","ALBUTEROL","FAT E","8.5","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","16714029904","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","50111078766","AZITHROMYCIN","TAB 250MG","4","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}