{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RALPH L PEARSON","gend":0,"add":"564 ROLLING RIDGE  LANE ","city":"WINCHESTER  ","state":"VA","zip":"22603-1630","dob":"1956-07-06","age":"","mstatus":"","insh":11018424,"cliId":"7DY6X00PA78","pno":5402472972,"cno":5402472972,"email":"","ename":"","eno":"","pphy":"HOUSER, ARCHILBALD","ppno":5406670744,"pcpadd":"1840 Amherst St","pcpcity":"Winchester  ","pcpstate":"VA","pcpzip":226012808,"pcpcounty":"","pcpid":"P0130344","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"564 Rolling Ridge Ln ","madd2":"","madd3":"","mcity":"Winchester  ","mstate":"VA","mzip":"22603-1630","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z12.5","B35.1","E66.01","Z13.6","Z13.220","J44.9","B19.20","H91.90","Z23","Z68.38","F17.201","E78.5","H90.5","Z12.2","Z87.891","D12.3","D12.2","D12.4","Z12.11","Z86.010","D12.0","K57.30","R01.1","M19.90"],"date":["2021-08-02","2021-09-07","2021-08-02","2021-08-02","2021-08-02","2021-11-02","2021-11-02","2021-08-02","2021-08-02","2021-08-02","2021-09-13","2021-09-13","2021-09-30","2021-09-25","2021-09-25","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-11-02"],"priorHcc":["","","","","",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":[]},{"a":[]}]},{"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":[["","68180096301","ALBUTEROL","HFA","8.5","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","49281040020","ADACEL","","0.5","Select","Select",""],["","65862007930","TERBINAFINE","250MG","30","Select","Select",""],["","70461012103","FLUAD","2021-22","0.5","Select","Select",""],["","65862007930","TERBINAFINE ","TAB 250MG","30","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50\/0.5ML","1","Select","Select",""],["","70461012103","FLUAD ","INJ 2021-22","0.5","Select","Select",""],["","68180096301","ALBUTEROL ","AER HFA","25.5","Select","Select",""],["","49281040020","ADACEL ","INJ ","0.5","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":""}]}]}