{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" SEMAJSSERK","gend":0,"add":"LIAR 472NL DAOR","city":"DARLINGTN HTS","state":"VA","zip":"23958-9998","dob":"1953-11-28","age":"","mstatus":"","insh":"10118908","cliId":"","pno":"6643433204","cno":"","email":"","ename":"","eno":"","pphy":"BURROUGHS, JOEL","ppno":4343387774,"pcpadd":"925 Village Hwy, ","pcpcity":"Rustburg","pcpstate":"VA","pcpzip":245884591,"pcpcounty":"","pcpid":"","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"274 RAILROAD LN","madd2":"","madd3":"","mcity":"DARLINGTN HTS","mstate":"VA","mzip":"23958-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.5","R00.0","K80.20","K57.30","D18.09","R10.9","N39.0","R39.198","R33.8","R52","W19.XXXA","R33.9","Z01.818","T83.091A","Z97.8","K80.10","Z20.822","N40.1","G89.29","Z82.49","R74.8","N40.0","Z71.89","Z71.3","S36.90XA","R42","S09.90XA","R55","V29.49XA","Y92.410","Y93.89","S19.9XXA","M47.812","M48.02","S29.9XXA","M54.50","R11.2","R19.7","R30.0","M54.9","N13.30","Z90.49","R05.9"],"date":["2021-08-04","2021-06-28","2021-07-28","2021-07-12","2021-07-12","2022-03-14","2021-07-18","2021-07-18","2021-07-28","2022-03-14","2021-07-18","2021-07-18","2021-07-19","2021-07-22","2021-07-25","2021-07-28","2022-03-14","2021-07-28","2021-07-28","2021-07-28","2021-07-28","2021-08-04","2021-08-04","2021-08-04","2021-08-19","2021-08-19","2021-08-19","2021-08-19","2021-08-19","2021-08-19","2021-08-19","2021-08-19","2021-08-19","2021-08-19","2021-08-19","2021-11-27","2021-11-27","2021-11-27","2021-11-27","2022-03-14","2022-03-14","2022-03-14","2022-03-14"],"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":[["","53746018801","NAPROXEN","TAB 250MG","14","Select","Select",""],["","65862059805","TAMSULOSIN","CAP 0.4MG","90","Select","Select",""],["","29300012410","MELOXICAM","TAB 7.5MG","30","Select","Select",""],["","65862085999","FAMOTIDINE","TAB 20MG","14","Select","Select",""],["","65862001901","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","57237023305","SMZ-TMP","TAB 800-160","28","Select","Select",""],["","27808003503","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","43547040011","CYCLOBENZAPR","TAB 10MG","10","Select","Select",""],["","72888008000","TRAMADOL","TAB 50MG","20.00","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}