{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DENISE J SCOTT","gend":1,"add":"1307 AMHERST AVE","city":"ALTAVISTA","state":"VA","zip":245179999,"dob":"1964-08-31","age":"","mstatus":"","insh":11003061,"cliId":"9KA1E90YU24","pno":4346107082,"cno":"","email":"","ename":"","eno":"","pphy":"ELLIOTT, ROBERT","ppno":4343528235,"pcpadd":"527 Pocket Rd","pcpcity":"Hurt","pcpstate":"VA","pcpzip":245632023,"pcpcounty":"","pcpid":"P9307464","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"VPHP - VIRGINIA PREMIER","program":"Medicare","lob":"DSNP","region":"WESTERN\/CHARLOTTESVILLE","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["E11.9","I10","Z68.41","J01.90","J20.9","R05","L30.9","J30.1","E78.1","J30.2","M17.11","E55.9","E66.01","Z72.0","Z12.11","H25.13","H35.033","H04.123","R73.01","M25.561","E11.65","I11.9","Z01.419","D50.9","Z72.89","Z00.01","M54.12","Z23","I67.1","F17.200"],"date":["2019-04-02","2020-11-11","2020-11-11","2019-01-08","2019-02-04","2019-02-04","2019-03-14","2019-03-14","2019-10-21","2020-11-11","2019-07-30","2020-11-11","2020-11-11","2020-11-11","2019-10-21","2018-05-07","2018-05-07","2018-05-07","2018-05-31","2019-07-30","2020-11-11","2019-07-09","2018-09-10","2020-11-11","2019-10-21","2020-11-11","2019-10-21","2019-10-21","2019-10-21","2020-11-11"],"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":[]}},{"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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","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":""}]}]}