{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GINGER DECHANT","gend":1,"add":"1868 ROUND MTN LOOP  ","city":"MADISON HEIGHTS","state":"VA","zip":"24572-4230","dob":"1979-12-24","age":"","mstatus":"","insh":11018440,"cliId":"2J45YR2GU68","pno":4345283616,"cno":4345283616,"email":"","ename":"","eno":"","pphy":"ALBERS, GREGG  ","ppno":4348468421,"pcpadd":"2811 Linkhorne Dr Ste A","pcpcity":"Lynchburg","pcpstate":"VA","pcpzip":245033354,"pcpcounty":"","pcpid":"P9307475","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"N","ano":"","add2":"","add3":"","madd1":"1868 ROUND MTN LOOP  ","madd2":"","madd3":"","mcity":"MADISON HEIGHTS","mstate":"VA","mzip":"24572-4230","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F32.9","F41.9","G89.29","I10","E05.90","Z13.0"],"date":["2021-09-28","2021-08-06","2021-09-28","2021-09-28","2021-09-28","2021-09-28"],"priorHcc":[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":[["","16714061305","SERTRALINE","100MG","60","Select","Select",""],["","68180096301","ALBUTEROL","HFA","8.5","Select","Select",""],["","31722055190","LEVOCETIRIZI","5MG","30","Select","Select",""],["","55111016730","OLANZAPINE","15MG","30","Select","Select",""],["","16714007106","BACLOFEN","10MG","90","Select","Select",""],["","68382005001","MELOXICAM","7.5MG","30","Select","Select",""],["","16729013716","CLONAZEPAM","1MG","60","Select","Select",""],["","51293082101","METHIMAZOLE","10MG","180","Select","Select",""],["","65862057490","MONTELUKAST","10MG","30","Select","Select",""],["","16714066202","GABAPENTIN","300MG","90","Select","Select",""],["","65862006299","METOPROL","25MG","30","Select","Select",""],["","16714007106","BACLOFEN ","TAB 10MG","90","Select","Select",""],["","65862006299","METOPROL ","TAB 25MG","30","Select","Select",""],["","68180096301","ALBUTEROL ","AER HFA","8.5","Select","Select",""],["","68382005001","MELOXICAM ","TAB 7.5MG","30","Select","Select",""],["","31722055190","LEVOCETIRIZI ","TAB 5MG","30","Select","Select",""],["","51293082101","METHIMAZOLE ","TAB 10MG","180","Select","Select",""],["","55111016730","OLANZAPINE ","TAB 15MG","30","Select","Select",""],["","16714061305","SERTRALINE ","TAB 100MG","60","Select","Select",""],["","65862057490","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","16714066202","GABAPENTIN ","CAP 300MG","90","Select","Select",""],["","16729013716","CLONAZEPAM ","TAB 1MG","60","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","",""],["No","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":""}]}]}