{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NICHOLAS   R BRYANT","gend":0,"add":"11 WINDCREST DRIVE                                          ","city":"LYNCHBURG                     ","state":"VA","zip":"24502-6837","dob":"2001-06-24","age":"","mstatus":"","insh":10051313,"cliId":"","pno":4349440453,"cno":4349440453,"email":"","ename":"","eno":"","pphy":"ELLIOTT, ROBERT                                             ","ppno":"","pcpadd":"527 Pocket Rd,Ste 101","pcpcity":"Hurt                          ","pcpstate":"VA","pcpzip":245632023,"pcpcounty":"","pcpid":"P9307471","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"11 WINDCREST DRIVE                                          ","madd2":"                                                            ","madd3":"","mcity":"LYNCHBURG                     ","mstate":"VA","mzip":"24502-6837","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F90.2","F84.0","F79","L02.01","F41.9","F40.10","F70","F80.2","Z23"],"date":["2021-08-02","2021-08-02","2019-06-19","2019-01-18","2019-06-19","2021-08-02","2021-08-02","2021-02-15","2021-02-25"],"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":[]},{"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":[["","13668013601","ESCITALOPRAM","10MG","45","Select","Select",""],["","13811070710","METHYLPHENID","27MG ER","30","Select","Select",""],["","16729020001","BUSPIRONE","5MG","270","Select","Select",""],["","13668013601","ESCITALOPRAM ","TAB 10MG","45","Select","Select",""],["","13811070710","METHYLPHENID ","TAB 27MG ER","30","Select","Select",""],["","16729020001","BUSPIRONE ","TAB 5MG","270","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","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","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":""}]}]}