{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALICE RANDOLPH","gend":1,"add":"1220 MOSELEY DRIVE","city":"LYNCHBURG","state":"VA","zip":"24502-9998","dob":"1945-01-24","age":"","mstatus":"","insh":11002983,"cliId":"8AK4T19KU01","pno":4349445440,"cno":4343292266,"email":"","ename":"","eno":"","pphy":"ANDERSON, ANDREW J","ppno":7578752009,"pcpadd":"20304 TIMBERLAKE ROAD","pcpcity":"LYNCHBURG","pcpstate":"VA","pcpzip":245027222,"pcpcounty":"","pcpid":"P9120196","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"apt 30","add3":"","madd1":"1220 MOSELEY DRIVE","madd2":"","madd3":"","mcity":"LYNCHBURG","mstate":"VA","mzip":"24502-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["H25.13","H40.1134","I12.9","N18.2","I25.10","E78.5","I10","Z91.14","Z95.5","Z12.31","H40.1132","H04.123","Z78.9","Z12.11","Z12.12","H25.11","Z11.59","H25.9","H69.80","J30.2","R42","R26.2","H81.12","R25.2","N18.9","H40.10X2","M25.511","M54.2","G56.01","G56.02","G56.03","H93.19","K59.00","I21.21","R07.9","E78.2","E87.6","T50.2X5A","Z79.02","Z79.82","Z79.899","Z87.891","Z88.6","Z83.3","I21.4","R07.89","I21.29","I25.82","M75.111","M75.21","I25.2","I73.9","Z68.25","N18.4","Z95.1","R92.8","Z01.812","Z20.828","N64.89","Z20.822","Z91.89"],"date":["2020-05-07","2019-01-28","2021-08-09","2018-02-28","2021-08-09","2021-08-09","2021-08-09","2021-06-04","2020-11-12","2021-03-17","2021-07-23","2021-01-14","2019-04-04","2019-04-15","2019-04-15","2020-05-19","2020-06-11","2020-06-16","2019-05-30","2019-05-30","2019-06-17","2019-06-18","2019-06-18","2020-07-13","2020-07-13","2018-08-01","2020-11-03","2020-09-24","2021-04-12","2020-09-24","2021-03-16","2019-10-07","2019-10-07","2019-10-31","2019-10-31","2019-10-31","2019-11-11","2019-10-31","2019-10-31","2021-06-04","2019-11-18","2021-06-04","2019-10-31","2019-10-31","2019-11-18","2019-10-31","2019-11-01","2019-11-18","2020-11-03","2020-11-03","2019-11-18","2019-11-18","2018-11-21","2021-08-09","2021-08-09","2021-03-26","2021-04-05","2021-04-05","2021-03-26","2021-04-05","2021-09-21"],"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":[["","24208046325","LATANOPROST","SOL 0.00005","","Select","Select",""],["","68382013516","LOSARTAN POT","TAB 25MG","","Select","Select",""],["","61314063705","PREDNISOLONE","SUS 1% OP","","Select","Select",""],["","16729018201","HYDROCHLOROT","TAB 12.5MG","","Select","Select",""],["","65862029590","ROSUVASTATIN","TAB 20MG","","Select","Select",""],["","17478071310","OFLOXACIN","DRO 0.3% OP","","Select","Select",""],["","55111019630","CLOPIDOGREL","TAB 75MG","","Select","Select",""],["","406012301","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","57237007810","ONDANSETRON","TAB 8MG ODT","","Select","Select",""],["","70377003012","ATORVASTATIN","TAB 80MG","","Select","Select",""],["","68382009201","CARVEDILOL","TAB 3.125MG","","Select","Select",""],["","68180051303","LISINOPRIL","TAB 5MG","","Select","Select",""],["","61314022505","TIMOLOL GEL","SOL 0.5% OP","","Select","Select",""],["","47335022090","KETOROLAC","SOL 0.005","","Select","Select",""],["","61314063705","PREDNISOLONE ","SUS 1% OP","5","Select","Select",""],["","24208046325","LATANOPROST ","SOL 0.00005","2.5","Select","Select",""],["","16729018201","HYDROCHLOROT ","TAB 12.5MG","90","Select","Select",""],["","68382013516","LOSARTAN ","TAB 25MG","90","Select","Select",""],["","47335022090","KETOROLAC ","SOL 0.005","5","Select","Select",""],["","17478071310","OFLOXACIN ","DRO 0.3% OP","5","Select","Select",""],["","65862029590","ROSUVASTATIN ","TAB 20MG","90","Select","Select",""],["","68382009201","CARVEDILOL ","TAB 3.125MG","180","Select","Select",""],["","55111019630","CLOPIDOGREL ","TAB 75MG","90","Select","Select",""],["","70377003012","ATORVASTATIN ","TAB 80MG","90","Select","Select",""],["","406012301","HYDROCO\/APAP ","TAB 5-325MG","10","Select","Select",""],["","57237007810","ONDANSETRON ","TAB 8MG ODT","10","Select","Select",""],["","68180051303","LISINOPRIL ","TAB 5MG","30","Select","Select",""],["","61314022505","TIMOLOL ","0.5% OP","5","Select","Select",""],["","68382013516","LOSARTAN","25MG","90","Select","Select",""],["","61314022505","TIMOLOL","0.5% OP","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","",""],["Yes","Select","","","","","Select","",""],["No","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":""}]}]}