{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LARRY R HILL","gend":0,"add":"441 CRESTWOOD ROAD","city":"COLLINSVILLE","state":"VA","zip":"24078-2850","dob":"1968-04-15","age":"","mstatus":"","insh":11016635,"cliId":"1K53UT2RF88","pno":2766222479,"cno":2766222479,"email":"","ename":"","eno":"","pphy":"MAHONEY, MARK T","ppno":2766660500,"pcpadd":"100 College Dr","pcpcity":"Martinsville","pcpstate":"VA","pcpzip":241127588,"pcpcounty":"","pcpid":"P9442992","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"APT 4 ","add3":"","madd1":"441 CRESTWOOD ROAD","madd2":"APT 4 ","madd3":"","mcity":"COLLINSVILLE","mstate":"VA","mzip":"24078-2850","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["F31.9","F41.9","F17.200","E03.9","N31.9","N28.1","G62.9","E78.1","S24.103A","L30.9","J01.00","R33.9","G82.20","S24.0XXA","R89.9","J01.10","Z13.0","Z13.228","J30.89","Z23","Z72.0","S09.90XD"],"date":["2021-11-18","2021-11-18","2021-03-18","2021-09-13","2021-11-20","2021-02-17","2021-11-09","2021-11-09","2021-07-12","2021-04-02","2020-12-29","2021-11-20","2021-11-20","2021-05-17","2021-07-20","2021-07-12","2021-11-09","2021-11-09","2021-11-09","2021-11-09","2021-11-18","2021-11-18"],"priorHcc":[null,null,"","",null,"",null,null,"","","",null,null,"","","",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":[["","72305015030","EUTHYROX","150MCG","30","Select","Select",""],["","00093505798","ATORVASTATIN ","TAB 80MG","90","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","29300022019","MONTELUKAST ","TAB 10MG","90","Select","Select",""],["","72305015030","EUTHYROX ","TAB 150MCG","30","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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","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":""}]}]}