{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CAROLYN L BARKER","gend":1,"add":"11612 MOUNT CROSS RD","city":"DANVILLE","state":"VA","zip":245409999,"dob":"1973-09-26","age":"","mstatus":"","insh":11016247,"cliId":"4K06XW3HY50","pno":5405058989,"cno":"","email":"","ename":"","eno":"","pphy":"METZLER, KEITH A","ppno":4345822273,"pcpadd":"3300 Rivermont Ave","pcpcity":"Lynchburg","pcpstate":"VA","pcpzip":245032030,"pcpcounty":"","pcpid":"P9307467","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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["R07.9","R06.02","Z88.6","Z86.711","H54.40","E11.65","R00.2","R81","E11.9","M62.831","R25.2","H54.8","R79.1","I26.99","I25.10","D64.9","I82.621","I26.94","K76.0","K59.00","H90.A22","H93.13","J45.50","I82.629","Z78.9","E66.01","Z68.42","J30.9","R59.0","N64.52"],"date":["2020-12-14","2020-10-27","2020-10-12","2020-10-19","2020-10-12","2020-10-13","2020-10-28","2020-10-13","2020-10-13","2020-10-19","2020-10-19","2020-10-19","2020-10-19","2021-03-29","2020-10-28","2020-11-11","2020-11-11","2020-11-11","2020-11-17","2020-11-17","2020-11-19","2020-11-19","2021-03-29","2021-03-29","2021-03-29","2021-03-29","2021-03-29","2021-03-29","2021-03-29","2021-03-01"],"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":[["","3089421","ELIQUIS","TAB 5MG","","Select","Select",""],["","53885044801","ONETOUCH","KIT ULTRA 2","","Select","Select",""],["","115703301","FLUDROCORT","TAB 0.1MG","","Select","Select",""],["","70377000812","ROSUVASTATIN","TAB 20MG","","Select","Select",""],["","59651024701","MIDODRINE","TAB 5MG","","Select","Select",""],["","57664050658","METOPROL TAR","TAB 25MG","","Select","Select",""],["","59651017301","DOXEPIN HCL","CAP 10MG","","Select","Select",""],["","66993066430","DULOXETINE","CAP 60MG","","Select","Select",""],["","378064205","PREDNISONE","TAB 20MG","","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","","Select","Select",""],["","68382075810","METFORMIN","TAB 500MG","","Select","Select",""],["","8290320119","BD PEN NEEDL","MIS 31GX5MM","","Select","Select",""],["","43598043611","NITROGLYCERN","SUB 0.4MG","","Select","Select",""],["","169406013","VICTOZA","INJ 18MG\/3ML","","Select","Select",""],["","59746021110","CYCLOBENZAPR","TAB 5MG","","Select","Select",""],["","99073070805","FREESTYLE","MIS LITE","","Select","Select",""],["","93005805","TRAMADOL HCL","TAB 50MG","","Select","Select",""],["","43547030703","ARIPIPRAZOLE","TAB 30MG","","Select","Select",""],["","43547029010","BUPROPION","TAB 200MG SR","","Select","Select",""],["","68180016113","AZITHROMYCIN","TAB 500MG","","Select","Select",""],["","245531911","KLOR-CON M20","TAB 20MEQ ER","","Select","Select",""],["","93101042","MUPIROCIN","OIN 0.02","","Select","Select",""],["","50458060901","INVEGA TRINZ","INJ 819MG","","Select","Select",""],["","60505014101","GLIPIZIDE","TAB 5MG","","Select","Select",""],["","832054111","BUMETANIDE","TAB 1MG","","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":[[["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Select","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":""}]}]}