{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JERAMY REYNOLDS","gend":0,"add":"3112 MARYLAND AVE ","city":"LYNCHBURG","state":"VA","zip":"24501-9998","dob":"1991-09-03","age":"","mstatus":"","insh":11012800,"cliId":"5YV9WF0YV41","pno":4344441520,"cno":4344441520,"email":"","ename":"","eno":"","pphy":"PERALTA, MANUEL T ","ppno":4348467374,"pcpadd":"2103 Graves Mill Rd","pcpcity":"Forest","pcpstate":"VA","pcpzip":245512675,"pcpcounty":"","pcpid":"P9307474","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"3112 MARYLAND 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":["G40.814","R39.81","L22","G40.812","G93.40","G40.909","G25.3","F84.0","Z99.3","L11.0","K21.9","Z68.25","B35.1"],"date":["2020-04-07","2021-10-17","2021-10-17","2021-10-17","2021-10-17","2020-08-20","2020-08-20","2020-08-20","2020-08-20","2020-07-28","2021-11-24","2020-07-28","2021-11-24"],"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":[["","51991090001","CLOBAZAM","TAB 10MG","","Select","Select",""],["","131247835","VIMPAT","TAB 100MG","","Select","Select",""],["","62559073101","FELBAMATE","TAB 600MG","","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","832058011","CLOBAZAM ","TAB 10MG","360","Select","Select",""],["","131247835","VIMPAT ","TAB 100MG","180","Select","Select",""],["","62559073101","FELBAMATE ","TAB 600MG","540","Select","Select",""],["","55111015810","OMEPRAZOLE ","CAP 20MG","90","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","",""],["No","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":""}]}]}