{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BEVERLEY J DOSS","gend":1,"add":"157 Parkwood Dr","city":"Madison Heights","state":"VA","zip":"24572-4318","dob":"1957-03-22","age":"","mstatus":"","insh":11007390,"cliId":"6G19UY9CK00","pno":4346100307,"cno":4345460457,"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":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"157 Parkwood Dr","madd2":"","madd3":"","mcity":"Madison Heights","mstate":"VA","mzip":"24572-4318","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["N39.3","F79","F42.9","J01.10","G40.909","R73.09","D64.9","E03.9","H04.129","E55.9","J30.2","H25.13","Z71.3","L72.3","L60.0","M79.674","M79.675","L60.8","E88.09","I95.9","R60.1","Z51.81","E16.2","Z23","Z13.31","R63.4","K59.00","M25.561","F41.8","R32","F71","W57.XXXA","R21","R35.0","Z00.00","F39"],"date":["2021-11-19","2021-11-19","2021-10-28","2020-03-19","2021-04-12","2020-04-24","2020-10-26","2021-09-15","2020-04-24","2020-04-24","2020-04-24","2020-05-11","2020-05-28","2019-06-17","2019-06-17","2019-06-17","2019-06-17","2019-06-17","2019-10-16","2019-10-16","2019-10-16","2020-10-22","2021-09-15","2021-09-15","2019-10-23","2019-10-23","2020-10-26","2020-10-26","2019-10-23","2020-10-26","2021-03-25","2021-04-12","2021-04-12","2021-04-12","2021-09-15","2021-09-15"],"priorHcc":[null,null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","68382009706","PAROXETINE","TAB 10MG","","Select","Select",""],["","70461032003","FLUCLVX QUAD","INJ 2020-21","","Select","Select",""],["","68001010603","DIVALPROEX","TAB 500MG ER","","Select","Select",""],["","69238183401","LEVOTHYROXIN","TAB 100MCG","","Select","Select",""],["","57237013901","TORSEMIDE","TAB 10MG","","Select","Select",""],["","781261305","AMOXICILLIN","CAP 500MG","","Select","Select",""],["","8484073200","PRODIGY NO","TES CODING","","Select","Select",""],["","8484081028","PRODIGY","MIS 28G","","Select","Select",""],["","68001010603","DIVALPROEX ","TAB 500MG ER","31","Select","Select",""],["","70461032003","FLUCLVX ","INJ 2020-21","0.5","Select","Select",""],["","68382009706","PAROXETINE ","TAB 10MG","62","Select","Select",""],["","69238183401","LEVOTHYROXIN ","TAB 100MCG","31","Select","Select",""],["","57237013901","TORSEMIDE ","TAB 10MG","31","Select","Select",""],["","781261305","AMOXICILLIN ","CAP 500MG","30","Select","Select",""],["","8484073200","PRODIGY ","TES CODING","100","Select","Select",""],["","62135098550","DOXYCYCL ","CAP 100MG","28","Select","Select",""],["","70461032003","FLUCLVX","2020-21","0.5","Select","Select",""],["","62135098550","DOXYCYCL","100MG","28","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","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":""}]}]}