{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"QI LING","gend":0,"add":"1503 KEMPER ST APT 102  ","city":"LYNCHBURG","state":"VA","zip":"24501-9998","dob":"1984-08-26","age":"","mstatus":"","insh":11016045,"cliId":"1AF7QN2XM42","pno":4348182935,"cno":4343338000,"email":"","ename":"","eno":"","pphy":"ALBERS, GREGG  ","ppno":4348468421,"pcpadd":"2811 Linkhorne Dr Ste A","pcpcity":"Lynchburg","pcpstate":"VA","pcpzip":245033354,"pcpcounty":"","pcpid":"P9307472","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1503 KEMPER ST APT 102  ","madd2":"","madd3":"","mcity":"LYNCHBURG","mstate":"VA","mzip":"24501-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["ASIAN\/PACIFIC"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["F31.2","I10","R73.09","R73.03","F31.9","E11.9","E78.5","E66.9","H52.31","Z68.32","F31.78","Z23","M25.561","M25.562","G89.29"],"date":["2021-11-22","2021-10-13","2021-02-11","2021-06-11","2021-09-13","2021-10-13","2021-09-13","2020-12-07","2020-12-07","2020-12-07","2021-06-10","2021-01-13","2021-10-13","2021-10-13","2021-10-13"],"priorHcc":[null,null,"","","",null,"","","","","","",null,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":[["","54253125","LITHIUM CARB","CAP 600MG","","Select","Select",""],["","68180038909","FENOFIBRATE","TAB 145MG","","Select","Select",""],["","43975035203","PALIPERIDONE","TAB ER 9MG","","Select","Select",""],["","70461032003","FLUCLVX QUAD","INJ 2020-21","","Select","Select",""],["","68180051303","LISINOPRIL","TAB 5MG","","Select","Select",""],["","66993068330","OLANZAPINE","TAB 10MG","","Select","Select",""],["","68382075810","METFORMIN","TAB 500MG","","Select","Select",""],["","68180038909","FENOFIBRATE ","TAB 145MG","90","Select","Select",""],["","54253125","LITHIUM ","CAP 600MG","180","Select","Select",""],["","43975035203","PALIPERIDONE ","TAB ER 9MG","90","Select","Select",""],["","68180051303","LISINOPRIL ","TAB 5MG","90","Select","Select",""],["","68382075810","METFORMIN ","TAB 500MG","90","Select","Select",""],["","66993068330","OLANZAPINE ","TAB 10MG","90","Select","Select",""],["","70461032003","FLUCLVX ","INJ 2020-21","0.5","Select","Select",""],["","00054253125","LITHIUM","600MG","180","Select","Select",""],["","70461032003","FLUCLVX","2020-21","0.5","Select","Select",""],["","31722070090","LOSARTAN","25MG","30","Select","Select",""],["","31722070090","LOSARTAN ","TAB 25MG","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":[[["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":""}]}]}