{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DOROTHY WHITE","gend":1,"add":"2359 CAMPBELL AVE ","city":"LYNCHBURG","state":"VA","zip":"24501-9998","dob":"1935-06-10","age":"","mstatus":"","insh":11010617,"cliId":"9VV2JW9JM04","pno":4344016827,"cno":4344016827,"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":"2359 CAMPBELL AVE ","madd2":"","madd3":"","mcity":"LYNCHBURG","mstate":"VA","mzip":"24501-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["G82.20","R39.81","R15.9","G93.40","L22","J10.1","E11.9","E78.5","F32.9","R05","Z87.891","I10","J45.909","Z79.899","Z79.4","R06.02","R41.0","R53.1","J96.00","N39.0","E78.2","F33.1","G89.4","K21.0","M19.91","Z23","Z13.31","Z86.718","E66.01","R35.0","Z20.822","M12.519","Z74.01","B37.2","Z79.01","K59.09","D68.59"],"date":["2021-03-11","2021-09-25","2021-09-25","2021-09-25","2021-09-25","2020-03-02","2021-08-05","2020-03-02","2020-03-02","2020-03-02","2020-03-02","2021-08-05","2020-03-02","2020-03-02","2020-03-02","2020-03-02","2020-03-02","2021-11-05","2020-05-20","2020-05-11","2021-08-05","2021-08-05","2021-08-05","2020-08-28","2020-08-28","2020-08-28","2020-08-28","2021-08-05","2021-08-05","2021-01-12","2021-02-02","2021-08-05","2021-08-05","2021-08-05","2021-08-05","2021-08-05","2021-08-05"],"priorHcc":["","","","","","","","","","","","","","","","","",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":[["","228202750","ALPRAZOLAM","TAB 0.25MG","","Select","Select",""],["","55111064530","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","406012401","HYDROCO\/APAP","TAB 7.5-325","","Select","Select",""],["","45802005911","NYSTATIN","CRE 100000","","Select","Select",""],["","45802006435","TRIAMCINOLON","CRE 0.001","","Select","Select",""],["","169368712","LEVEMIR","INJ ","","Select","Select",""],["","68645057054","CITALOPRAM","TAB 20MG","","Select","Select",""],["","65702040810","ACCU-CHEK","TES AVIVA PL","","Select","Select",""],["","8290324912","INSULIN SYRG","MIS 1ML\/31G","","Select","Select",""],["","50458057990","XARELTO","TAB 20MG","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","65162027250","SMZ\/TMP DS","TAB 800-160","","Select","Select",""],["","69238126601","OSELTAMIVIR","CAP 75MG","","Select","Select",""],["","65162047810","NITROFURANTN","CAP 100MG","","Select","Select",""],["","406012401","HYDROCO\/APAP ","TAB 7.5-325","120","Select","Select",""],["","228202750","ALPRAZOLAM ","TAB 0.25MG","90","Select","Select",""],["","68645057054","CITALOPRAM ","TAB 20MG","90","Select","Select",""],["","55111064530","OMEPRAZOLE ","CAP 40MG","90","Select","Select",""],["","169368712","LEVEMIR ","INJ ","10","Select","Select",""],["","45802005911","NYSTATIN ","CRE 100000","240","Select","Select",""],["","45802006435","TRIAMCINOLON ","CRE 0.001","45","Select","Select",""],["","50458057990","XARELTO ","TAB 20MG","90","Select","Select",""],["","65162047810","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","8290324912","INSULIN ","MIS 1ML\/31G","100","Select","Select",""],["","65702040810","ACCU-CHEK ","TES AVIVA PL","100","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","69238126601","OSELTAMIVIR ","CAP 75MG","10","Select","Select",""],["","65162027250","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","57599080000","FREESTY","2 SENSOR","6","Select","Select",""],["","08290324912","INSULIN","1ML\/31G","100","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""],["","65162027250","SMZ\/TMP","800-160","20","Select","Select",""],["","57599080000","FREESTY ","KIT 2 SENSOR","6","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","",""],["No","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":""}]}]}