{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHASE   L MAXEY","gend":0,"add":"312 GRANDVIEW DRIVE","city":"AMHERST                       ","state":"VA","zip":"24521-3124","dob":"2003-10-12","age":"","mstatus":"","insh":4867907,"cliId":"","pno":4349072460,"cno":4349074809,"email":"","ename":"","eno":"","pphy":"SHAHADY, GERTRUDE K","ppno":4348467374,"pcpadd":"925 Village Hwy,Village Med Center","pcpcity":"Rustburg                      ","pcpstate":"VA","pcpzip":245884591,"pcpcounty":"","pcpid":"","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"312 GRANDVIEW DRIVE","add3":"","madd1":"312 GRANDVIEW DRIVE","madd2":"","madd3":"","mcity":"AMHERST                       ","mstate":"VA","mzip":"24521-3124","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F91.2","F91.1","F07.81","J40","R50.9","R68.89","Z78.9","R45.851","F32.9","F12.90","F17.210","Z20.828","Z79.899","Z88.0","F43.21","F12.20","F19.21","F90.9","Z20.822","F33.1","F39","F12.10","F14.10","F15.10","Z62.810","Z91.5","R63.6","F19.10","F33.2","Z00.121","Z00.129","Z72.0","Z23","F15.20","F17.200","F90.2","K59.00","F29","F14.20","Z59.0","F33.3","S60.221A","F15.99","X78.9XXA","Y92.9","F13.20","F15.21","F10.10","F11.10","F19.94","F19.14","S41.119A","S61.511A","S61.512A"],"date":["2020-04-28","2020-09-22","2020-02-04","2020-03-06","2020-03-06","2020-03-06","2020-03-06","2021-09-21","2021-09-21","2020-12-30","2021-12-14","2020-12-30","2021-09-21","2021-09-21","2021-01-04","2021-09-22","2021-01-01","2021-01-01","2021-12-14","2021-10-04","2021-03-12","2021-08-06","2021-03-12","2021-08-06","2021-09-22","2021-09-22","2021-03-13","2021-08-07","2021-03-18","2021-03-25","2021-04-01","2021-03-30","2021-03-30","2021-09-22","2021-09-22","2021-09-21","2021-08-17","2021-09-22","2021-12-14","2021-09-22","2021-12-14","2021-09-26","2021-10-06","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-12-14"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"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":[["","16729020201","BUSPIRONE","TAB 10MG","90","Select","Select",""],["","65862059401","DIVALPROEX","TAB 250MG ER","60","Select","Select",""],["","14539067501","HYDROXYZ","CAP 50MG","60","Select","Select",""],["","13668001005","CITALOPRAM","TAB 20MG","30","Select","Select",""],["","00536589588","NICOTINE","DIS 14MG\/24H","14","Select","Select",""],["","00904671760","CETIRIZINE","TAB 10MG","15","Select","Select",""],["","57664050083","MIRTAZAPINE","TAB 30MG","30","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","30","Select","Select",""],["","59779045839","CVS","TAB 10MG","30","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":""}]}]}