{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"M SALGUODSNIKNEJ ","gend":0,"add":"MDEIP E 203TEERTS TNO","city":"Culpeper","state":"VA","zip":"22701-2728","dob":"1951-07-10","age":"","mstatus":"","insh":"00112509","cliId":"","pno":"2204576649","cno":"","email":"","ename":"","eno":"","pphy":"CARRUTHERS, ABIGAIL","ppno":5403214281,"pcpadd":"15237 CREATIVITY DR,STE 105","pcpcity":"Culpeper","pcpstate":"VA","pcpzip":"22701-2504","pcpcounty":"","pcpid":"","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"N","ano":"","add2":"","add3":"","madd1":"302 E PIEDMONT STREET","madd2":"","madd3":"","mcity":"Culpeper","mstate":"VA","mzip":"22701-2728","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S82.831A","S82.191A","Z00.00","R03.0","R97.20","F17.200","R00.8","R05","W20.8XXA","N40.1","N13.8","S82.831D","S82.101D","R60.0","N52.9","S80.811A","M25.461","M25.561","M25.571","Z23","Z20.822","F17.210","R35.0","R39.12","Z79.51","J44.9","Z13.6","Z13.220","S99.911A","Z87.891","Z12.11","R39.11","S89.91XA","R05.9","R50.9","R07.81","J02.9","R00.1","R06.2","R07.89","R91.1","I65.23","I49.3","R94.31","I10","Z72.0","J06.9","R05.1","R00.9","Z79.899","R07.9","I49.1","E83.42","B02.9"],"date":["2022-09-22","2022-09-20","2019-12-10","2019-12-10","2021-08-25","2023-03-07","2022-12-07","2021-03-31","2022-09-01","2021-08-25","2021-08-25","2022-09-20","2022-09-20","2022-09-20","2021-06-14","2022-08-03","2022-08-03","2022-08-03","2022-08-03","2022-08-03","2022-12-07","2020-06-30","2021-08-25","2021-08-25","2021-08-25","2022-12-07","2021-06-14","2021-06-14","2022-08-03","2020-06-30","2020-12-14","2021-06-14","2022-08-03","2022-12-07","2022-12-07","2022-12-07","2022-12-07","2023-03-01","2022-12-07","2023-03-07","2022-12-07","2023-03-01","2023-03-07","2023-03-01","2023-05-18","2023-01-25","2022-12-07","2022-12-07","2022-12-07","2023-03-07","2023-03-07","2023-05-18","2023-05-18","2023-07-12"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","68180016013","AZITHROMYCIN TAB","250MG","6","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":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"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":""}]}]}