{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"INGA R LOKKEN","gend":1,"add":"4006   MIDLOTHIAN TURNPIKE","city":"RICHMOND","state":"VA","zip":232241355,"dob":"1998-04-14","age":"","mstatus":"","insh":11011497,"cliId":"3NP8P87KJ37","pno":4342214909,"cno":"","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 - VIRGINIA PREMIER","program":"Medicare","lob":"DSNP","region":"CENTRAL","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":["F31.81","F99","F60.3","F31.9","Z20.828","R45.851","T74.21XA","F12.10","F17.200","F41.1","F43.12","Z91.411","Z59.0","F39","F33.9","F43.10","R07.9","R06.02","F33.1","Z78.9","R20.2","M62.838","F41.0","F31.30","R46.89","M54.2","L29.9","F41.9","R03.0"],"date":["2020-10-23","2020-09-14","2020-12-15","2020-10-31","2020-10-27","2020-10-27","2020-10-27","2020-10-27","2020-10-27","2020-11-16","2020-10-27","2020-10-27","2020-10-27","2020-10-27","2020-11-03","2021-01-20","2020-10-28","2020-10-28","2020-11-08","2020-11-24","2020-03-04","2020-03-04","2020-03-04","2020-03-04","2020-03-04","2020-06-18","2020-06-18","2020-10-27","2020-10-27"],"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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}