{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DELOIS COLES","gend":1,"add":"PO BOX 33","city":"HURT","state":"VA","zip":245630033,"dob":"1935-02-17","age":"","mstatus":"","insh":11016087,"cliId":"3H71QT9UC07","pno":4343696970,"cno":"","email":"","ename":"","eno":"","pphy":"BROSE, TEODORA G","ppno":4343528235,"pcpadd":"131 Jones St","pcpcity":"Appomattox","pcpstate":"VA","pcpzip":245229830,"pcpcounty":"","pcpid":"P9307470","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":["N18.6","D63.1","N25.81","Z23","Z99.2","E11.65","I50.32","I11.0","J96.11","Z99.81","Z79.01","Z79.4","Z51.81","I48.19","E11.9","D50.9","R11.2","H40.42X3","H40.41X2","R11.10","I13.2","E11.22","I48.91","D64.9","I50.30","Z88.2","R53.1","K52.9","E11.649","I27.20","Z82.49","Z83.3","K57.30","R93.5","N26.1","R10.9","E21.1","K92.0","E16.2","K21.00","N18.5","E78.5","N39.490","H66.92","H40.43X3","R10.30","I10","K74.60","K76.89","I12.9","N28.1","K76.9","Z90.49"],"date":["2021-02-11","2021-02-10","2021-01-02","2020-10-01","2021-01-02","2020-11-23","2020-11-23","2020-11-23","2020-11-23","2020-11-23","2021-01-20","2020-11-23","2021-01-20","2021-01-20","2021-02-24","2021-01-02","2020-11-12","2020-11-09","2020-11-09","2020-11-23","2020-11-23","2020-11-12","2020-11-12","2021-02-09","2020-11-11","2020-11-11","2020-11-11","2020-11-12","2020-11-12","2020-11-23","2020-11-12","2020-11-12","2021-02-09","2020-11-12","2021-02-09","2020-11-23","2021-02-10","2020-11-12","2020-11-12","2020-11-23","2020-11-23","2020-11-23","2020-12-24","2021-01-08","2021-01-22","2021-02-08","2021-02-09","2021-02-09","2021-02-09","2021-02-10","2021-02-10","2021-02-10","2021-02-10"],"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","",""],["No","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":""}]}]}