{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PAUL J BROWN","gend":0,"add":"1035 DIAMOND CT","city":"CHARLOTTESVILLE","state":"VA","zip":"22902-9998","dob":"1961-02-08","age":"","mstatus":"","insh":11007647,"cliId":"3MV6UD2UW62","pno":4349873758,"cno":4344658609,"email":"","ename":"","eno":"","pphy":"CHRISTENSEN, MARISA  ","ppno":5409421200,"pcpadd":"1242 Cedars Ct","pcpcity":"Charlottesville","pcpstate":"VA","pcpzip":229034800,"pcpcounty":"","pcpid":"P9120193","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"RIDGEWOOD MOBILE HOME PARK ","madd2":"1450 RIDGEWOOD DR ","madd3":"","mcity":"CHARLOTTESVILLE","mstate":"VA","mzip":"22911-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["R05","R06.00","I10","Z91.89","E66.01","Z00.00","G56.03","Z79.899","M54.32","R20.0","R20.2","Z83.3","K21.9","Z76.0","M54.42","M54.9","M79.605","Z88.0","Z88.5","Z88.8","E66.9","Z23"],"date":["2020-08-07","2019-09-06","2021-11-07","2019-08-13","2019-08-13","2021-04-23","2019-08-13","2019-08-13","2021-11-12","2021-04-23","2021-04-23","2021-04-23","2021-04-23","2021-04-23","2021-11-07","2021-11-07","2021-11-07","2021-11-07","2021-11-07","2021-11-07","2021-11-07","2021-11-12"],"priorHcc":["","",null,"","","","","",null,"","","","","",null,null,null,null,null,null,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":[["","23155000810","HYDROCHLOROT","TAB 25MG","","Select","Select",""],["","65862051601","NAPROXEN SOD","TAB 550MG","","Select","Select",""],["","70377002811","ATORVASTATIN","TAB 20MG","","Select","Select",""],["","49281042050","FLUZONE QUAD","INJ 2020-21","","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","","Select","Select",""],["","70461031903","FLUCLVX QUAD","INJ 2019-20","","Select","Select",""],["","70377002811","ATORVASTATIN ","TAB 20MG","90","Select","Select",""],["","65862051601","NAPROXEN ","TAB 550MG","28","Select","Select",""],["","23155000810","HYDROCHLOROT ","TAB 25MG","45","Select","Select",""],["","55111015810","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0.5","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","1","Select","Select",""],["","70461031903","FLUCLVX ","2019-20","0.5","Select","Select",""],["","65862051601","NAPROXEN","550MG","28","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","30","Select","Select",""],["","70461031903","FLUCLVX","2019-20","0.5","Select","Select",""],["","49281042050","FLUZONE","2020-21","0.5","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","12","Select","Select",""],["","00378064205","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","69584061150","METHOCARBAM ","TAB 500MG","40","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":""}]}]}