{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DIANE E PHILLIPS","gend":1,"add":"256 BRIGHTWELL MILL RD","city":"MADISON HEIGHTS","state":"VA","zip":245729999,"dob":"1951-07-03","age":"","mstatus":"","insh":11013101,"cliId":"1VH1WQ2WN05","pno":4344263335,"cno":"","email":"","ename":"","eno":"","pphy":"BEVERLY, WALTER B","ppno":4349473908,"pcpadd":"130 Enterprise Dr","pcpcity":"Danville","pcpstate":"VA","pcpzip":245404070,"pcpcounty":"","pcpid":"P9307475","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"VPHP - VIRGINIA PREMIER","program":"Medicare","lob":"DSNP","region":"WESTERN\/CHARLOTTESVILLE","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":["E11.8","E11.621","L97.412","L84","E11.42","E78.5","I10","J44.9","I67.9","Z79.4","Z89.421","Z87.891","L97.511","I25.10","I11.0","I50.30","F03.90","G40.909","G25.81","M81.0","M10.9","M19.90","E55.9","E53.8","J45.909","G43.909","M25.561","T84.82XD","R29.898","Z96.651","M25.551","M70.61","M47.896","B35.1","L60.3","M19.011","Z86.31","Z79.82","L97.512","E11.9","Z91.81","Z86.73","Z79.891","Z51.81","M79.642","M19.049","R20.8","R60.0"],"date":["2020-08-05","2021-02-11","2021-02-11","2021-02-11","2021-02-11","2021-02-11","2021-02-11","2021-02-11","2021-02-11","2021-02-11","2021-02-11","2021-02-11","2020-05-13","2020-05-13","2020-05-13","2020-05-13","2020-05-13","2020-08-18","2020-05-13","2020-05-13","2020-05-13","2020-05-13","2020-05-13","2020-05-13","2020-05-13","2020-05-13","2020-06-11","2020-06-11","2020-06-11","2020-06-11","2020-05-14","2020-05-14","2020-09-11","2020-06-17","2020-06-17","2020-08-12","2020-09-01","2021-01-06","2021-01-06","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2021-02-24","2020-09-14","2020-09-14","2020-09-14","2021-02-11"],"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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}