{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARY R SPEAS","gend":1,"add":"MS. PAT SPEAS  ","city":"CUMBERLAND  ","state":"VA","zip":"23040-0220","dob":"1951-11-26","age":"","mstatus":"","insh":11002591,"cliId":"6X74HT5WC87","pno":8043873669,"cno":8042984049,"email":"","ename":"","eno":"","pphy":"ALBERS, GREGG  ","ppno":4348468421,"pcpadd":"2811 Linkhorne Dr Ste A","pcpcity":"Lynchburg","pcpstate":"VA","pcpzip":245033354,"pcpcounty":"","pcpid":"P9120196","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"P.O. BOX 220","add3":"","madd1":"MS. PAT SPEAS  ","madd2":"P.O. BOX 220","madd3":"","mcity":"CUMBERLAND  ","mstate":"VA","mzip":"23040-0220","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["I10","E78.5","E55.9","R73.03","E63.9","Z00.00","Z68.30","N76.0","Z12.11","Z68.32","Z23","K21.9","Z85.42","R42","J30.9","H61.23","C54.1","E78.00","J30.2","Z68.31","I44.7","R00.1","R94.31","R79.89","R68.89","R94.6","E66.9","Z78.9","H61.20","Z01.89","Z20.828","M81.0","Z13.820","Z78.0","Z12.31","F41.9"],"date":["2019-05-07","2021-10-22","2021-04-21","2019-05-07","2020-03-10","2020-03-10","2021-10-22","2019-03-20","2019-03-20","2019-03-20","2021-10-22","2021-10-22","2021-07-07","2018-06-19","2018-06-19","2018-06-19","2019-08-01","2019-11-20","2019-08-01","2018-10-10","2019-10-15","2019-11-20","2019-10-15","2019-10-16","2019-10-16","2019-10-16","2019-11-20","2021-04-21","2021-04-21","2021-04-21","2020-09-21","2021-05-10","2021-05-10","2021-05-10","2021-07-07","2021-10-22"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"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":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","60505267109","ATORVASTATIN","TAB 80MG","","Select","Select",""],["","61442012110","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","29300022010","MONTELUKAST","TAB 10MG","","Select","Select",""],["","65162025350","RANITIDINE","TAB 150MG","","Select","Select",""],["","51672128902","NYSTATIN","CRE 100000","","Select","Select",""],["","49281040565","FLUZONE HD","INJ PF 19-20","","Select","Select",""],["","67877031905","IBUPROFEN","TAB 400MG","","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","60505267109","ATORVASTATIN ","TAB 80MG","28","Select","Select",""],["","69452010532","MONTELUKAST ","TAB 10MG","28","Select","Select",""],["","65162025350","RANITIDINE ","TAB 150MG","56","Select","Select",""],["","51672128902","NYSTATIN ","CRE 100000","30","Select","Select",""],["","61442012110","FAMOTIDINE ","TAB 20MG","56","Select","Select",""],["","49281040565","FLUZONE ","INJ PF 19-20","0.5","Select","Select",""],["","67877031905","IBUPROFEN ","TAB 400MG","30","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","69097022416","ALENDRONATE ","70MG","4","Select","Select",""],["","69097022416","ALENDRONATE","70MG","4","Select","Select",""],["","49281040565","FLUZONE","PF 19-20","0.5","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}