{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ELLEN   J PETERSON","gend":1,"add":"1000   ROCKBRIDGE AVENUE                                    ","city":"LYNCHBURG                     ","state":"VA","zip":"24501-3202","dob":"1967-04-08","age":"","mstatus":"","insh":10053185,"cliId":"","pno":4342092617,"cno":4342092617,"email":"","ename":"","eno":"","pphy":"ELLIOTT, ROBERT                                             ","ppno":"","pcpadd":"527 Pocket Rd","pcpcity":"Hurt                          ","pcpstate":"VA","pcpzip":245632023,"pcpcounty":"","pcpid":"P9307472","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"APT D                                                       ","add3":"","madd1":"1000   ROCKBRIDGE AVENUE                                    ","madd2":"APT D                                                       ","madd3":"","mcity":"LYNCHBURG                     ","mstate":"VA","mzip":"24501-3202","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.62","L02.91","Z79.899","S09.90XA","R22.0","S06.0X0A","H83.2X9","R51.9","Z53.21"],"date":["2021-11-22","2020-11-16","2021-04-23","2021-08-10","2021-08-10","2021-08-16","2021-08-16","2021-08-10","2021-08-10"],"priorHcc":[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":[["","13107003234","MIRTAZAPINE","45MG","30","Select","Select",""],["","52817018010","CLONIDINE","0.1MG","90","Select","Select",""],["","13668013610","ESCITALOPRAM","10MG","90","Select","Select",""],["","00093406801","PRAZOSIN","2MG","30","Select","Select",""],["","70710134403","RAMELTEON","8MG","60","Select","Select",""],["","33342010409","QUETIAPINE","300MG","60","Select","Select",""],["","00536589688","NICOTINE","21MG\/24H","7","Select","Select",""],["","57237007530","ONDANSETRON","4MG","20","Select","Select",""],["","65862042001","SMZ\/TMP","800-160","14","Select","Select",""],["","13107003234","MIRTAZAPINE ","TAB 45MG","30","Select","Select",""],["","52817018010","CLONIDINE ","TAB 0.1MG","90","Select","Select",""],["","13668013610","ESCITALOPRAM ","TAB 10MG","90","Select","Select",""],["","00093406801","PRAZOSIN ","CAP 2MG","30","Select","Select",""],["","70710134403","RAMELTEON ","TAB 8MG","60","Select","Select",""],["","68180044701","QUETIAPINE ","TAB 100MG","60","Select","Select",""],["","00536589688","NICOTINE ","DIS 21MG\/24H","7","Select","Select",""],["","57237007530","ONDANSETRON ","TAB 4MG","20","Select","Select",""],["","65862042001","SMZ\/TMP ","TAB 800-160","14","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","",""],["Yes","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":""}]}]}