{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANGIE MORRIS","gend":1,"add":"146 SAFEWAY DR","city":"MADISON HEIGHTS","state":"VA","zip":245729999,"dob":"1945-09-20","age":"","mstatus":"","insh":11015669,"cliId":"4FC8E81CP21","pno":4342580532,"cno":4342580532,"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":"N","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":["N18.6","E21.3","D63.1","Z11.59","E11.9","K31.83","R52","Z99.2","T82.868A","Y83.2","T82.858A","I12.0","M62.81","L29.9","R19.7","R92.8","F41.8","Z23","R26.2","Z89.512","Z51.89","I73.9","S78.111A","K62.6","K62.5","K57.31","J96.11","I13.2","N25.81","I50.22","I48.20","K63.3","E11.22","E11.51","I25.10","E11.41","I27.29","R05","R91.8","R93.89","I48.91","Z79.01","I95.9","D64.9","K62.1","K92.1","K64.8","K64.4","K57.30","K63.5","R09.89","I51.7","I51.9","I10","E21.1","S06.5X9A","W05.0XXA","I48.0","S01.01XA","J98.6","I95.89","E87.5","Z79.899","S09.90XA","I62.00","S19.9XXA","S29.9XXA","J98.11","I62.01","G93.89","R90.89","R07.9","R06.02","I42.9","I38","I34.0","G57.90","J43.9","I27.20","I36.1","Z89.611","S06.5X0A","G23.8","R58","R74.8","I50.9","Z86.79","Z95.5","R79.89","N18.9","Z79.4","G47.30","S06.5X0D","G56.02","T82.590A","I21.09","I21.4","I82.221","I48.19","E87.1","T82.49XA","I49.2","R57.0","R06.9","E11.69","Z45.2","I96","L97.429","G89.18"],"date":["2021-02-18","2021-01-01","2021-02-18","2020-09-15","2020-12-02","2021-01-01","2021-02-07","2021-02-07","2021-02-07","2021-02-07","2021-02-09","2020-09-04","2021-01-13","2020-12-17","2020-09-15","2020-09-15","2020-12-17","2020-10-05","2020-09-15","2020-11-05","2020-11-05","2020-11-05","2020-09-17","2020-09-28","2020-10-04","2020-09-28","2021-02-07","2021-02-07","2021-02-07","2021-02-07","2020-11-01","2020-10-02","2020-10-31","2020-10-31","2021-02-07","2020-10-31","2020-10-31","2021-02-05","2020-10-30","2021-02-07","2020-10-02","2020-10-02","2021-02-07","2020-09-30","2020-10-02","2020-10-02","2020-10-02","2020-10-02","2020-10-02","2020-10-02","2020-10-04","2021-02-07","2021-02-21","2020-10-22","2020-10-22","2020-12-17","2020-10-19","2020-11-02","2020-10-19","2020-11-02","2020-10-19","2020-10-19","2020-10-19","2020-10-19","2020-10-29","2020-10-19","2020-10-19","2021-02-07","2020-10-20","2021-01-26","2020-10-29","2020-11-02","2021-02-07","2020-11-02","2020-11-02","2020-10-31","2020-10-31","2020-10-31","2021-02-18","2020-11-01","2020-11-05","2021-01-26","2020-12-03","2020-10-30","2020-10-30","2020-10-30","2020-10-30","2020-10-30","2020-11-02","2021-02-09","2020-10-31","2020-11-02","2021-01-26","2021-01-07","2021-02-06","2021-02-07","2021-02-07","2021-02-07","2021-02-07","2021-02-07","2021-02-07","2021-02-07","2021-02-07","2021-02-07","2021-02-18","2021-02-09","2020-03-03","2020-03-03","2020-03-03"],"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":""}]}]}