{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"R TENAJMAHSAB ","gend":1,"add":"        dvlB egdirkaO 904                         ","city":"Lynchburg                ","state":"VA","zip":"24502-4721","dob":"1959-10-22","age":"","mstatus":"","insh":"10118888","cliId":"","pno":"5243454478","cno":"","email":"","ename":"","eno":"","pphy":"RICHARDSON, PATRICIA C","ppno":4343387774,"pcpadd":"1606 REGENTS PARKWAY,","pcpcity":"LYNCHBURG","pcpstate":"VA","pcpzip":245150001,"pcpcounty":"","pcpid":"","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"N","ano":"","add2":"                                                  ","add3":"","madd1":"409 Oakridge Blvd                                 ","madd2":"                                                  ","madd3":"","mcity":"Lynchburg                ","mstate":"VA","mzip":"24502-4721","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.9","F33.2","H40.013","H25.13","H43.393","M10.9","Z72.0","I10","E78.2","R74.8","F41.8","Z72.89","F10.20","F41.1"," "],"date":["2022-07-22","2022-07-12","2022-04-26","2022-04-26","2022-04-26","2022-07-22","2022-07-22","2022-07-22","2022-07-22","2022-07-22","2022-07-22","2022-07-22","2022-07-22","2022-06-14","2022-07-22"],"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":[["","00093506201","HYDROXYZ","TAB 50MG","120.00","Select","Select",""],["","29300024601","BUSPIRONE","TAB 15MG","30.00","Select","Select",""],["","50228017905","GABAPENTIN","CAP 100MG","90.00","Select","Select",""],["","65862019399","FLUOXETINE","CAP 20MG","30.00","Select","Select",""],["","13107000334","MIRTAZAPINE","TAB 30MG","30.00","Select","Select",""],["","16729022601","SPIRONOLACT","TAB 50MG","30.00","Select","Select",""],["","67877039130","NEBIVOLOL","TAB 10MG","30","Select","Select",""],["","68180063809","ATORVASTATIN","TAB 80MG","30.00","Select","Select",""],["","59148003813","REXULTI","TAB 2MG","30.00","Select","Select",""],["","55111072901","ALLOPURINOL","TAB 100MG","90","Select","Select",""],["","63402030230","LATUDA","TAB 20MG","30.00","Select","Select",""],["","49281072210","FLUBLOK","INJ 2022-23","0.5","Select","Select",""],["","5200010","PREVNAR","INJ ","0.5","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":""}]}]}