{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ACISSEJRESSED A","gend":1,"add":"       EVIRD TSEROF   711                         ","city":"WINCHESTER               ","state":"VA","zip":"22603-5744","dob":"1982-07-21","age":"","mstatus":"","insh":"10119276","cliId":"","pno":"7804531257","cno":"","email":"","ename":"","eno":"","pphy":"WILLIAMS, MEGAN L","ppno":5406678724,"pcpadd":"1867 AMHERST ST,  ","pcpcity":"Winchester","pcpstate":"VA","pcpzip":226012801,"pcpcounty":"","pcpid":"","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"SUITE 103                                         ","add3":"","madd1":"117   FOREST DRIVE                                ","madd2":"SUITE 103                                         ","madd3":"","mcity":"WINCHESTER               ","mstate":"VA","mzip":"22603-5744","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F32.9","R03.0","E03.9","S93.621D","B35.3","Z00.00","R73.03","N89.8","B37.3","B37.2","Z01.419","F79","M72.2","L60.0","F09","F39","L02.91","M76.891","S93.621A","L02.92","Z01.411","L81.4","D22.5","D22.62","D22.71","D22.72","L82.1","B07.8","L90.5","D48.5","Z12.31","I10","S06.0X0A","Z74.3"],"date":["2022-06-07","2021-10-13","2022-03-01","2021-05-07","2021-05-07","2022-03-01","2022-03-01","2021-05-20","2021-05-20","2022-06-08","2021-05-20","2021-12-09","2022-07-19","2021-09-28","2022-03-01","2022-03-01","2022-01-28","2021-04-09","2021-04-09","2021-04-21","2021-05-20","2022-03-30","2022-03-30","2022-03-30","2022-03-30","2022-03-30","2022-03-30","2022-03-30","2022-03-30","2022-03-30","2022-06-08","2022-07-26","2022-05-02","2022-05-02"],"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":[["","16729028010","ARIPIPRAZOLE","TAB 10MG","90","Select","Select",""],["","00115166003","PROPRANOLOL","TAB 20MG","180","Select","Select",""],["","51672128902","NYSTATIN","CRE 100000","30","Select","Select",""],["","00378181110","LEVOTHYROXIN","TAB 112MCG","90","Select","Select",""],["","69097083512","SERTRALINE","TAB 100MG","180","Select","Select",""],["","59651036205","IBUPROFEN","TAB 800MG","28","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00172392770","DIAZEPAM","TAB 10MG","2","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","45802006336","TRIAMCINOLON","CRE 0.00025","80","Select","Select",""],["","13107005999","APAP\/CODEINE","TAB 300-30MG","10","Select","Select",""],["","00093321915","KETOCONAZOLE","CRE 0.02","30","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","24658031205","DOXYCYCL","TAB 100MG","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":["",""]}},{"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":""}]}]}