{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"E LEGNASDRAWD","gend":1,"add":"             EVA DN2 0023                         ","city":"RICHMOND                 ","state":"VA","zip":"23222-9998","dob":"1982-11-26","age":"","mstatus":"","insh":"00116435","cliId":"","pno":"9540833263","cno":8049467138,"email":"","ename":"","eno":"","pphy":"JACKSON, RICHARD A","ppno":8042257148,"pcpadd":"304 E LEIGH ST,","pcpcity":"Richmond","pcpstate":"VA","pcpzip":232191410,"pcpcounty":"","pcpid":"","pcpname":"DOMINION MEDICAL ASSOCIATES INC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"APT A                                             ","add3":"","madd1":"3200 2ND AVE                                      ","madd2":"APT A                                             ","madd3":"","mcity":"RICHMOND                 ","mstate":"VA","mzip":"23222-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z11.3","Z11.59","Z30.09","F33.1","U07.1","Z11.52","Z71.1","Z01.419","J30.2","F41.9","Z68.35","F17.200","I10","R79.9","Z92.29","R06.02","R79.89","E53.8","R53.1","R63.4","E55.9","Z79.899","R05","R09.81","B34.9","Z09","Z71.3","H93.299","Z00.00","R94.31","J30.9","H61.23","Z68.37","J45.909","R89.9","R68.89","J20.9","F32.9","F41.1","E66.9","Z87.891","Z68.30","N39.0","E83.42","I11.9","R35.0","R10.9","R51.9","R42"," ","J02.9","Z20.822","F17.210"],"date":["2021-01-05","2021-01-05","2021-01-05","2020-01-12","2022-01-07","2022-01-07","2020-01-10","2020-01-15","2022-03-25","2021-03-25","2020-02-06","2022-10-14","2022-03-25","2022-03-25","2022-03-25","2022-03-25","2022-03-25","2022-03-25","2020-09-18","2020-09-18","2022-03-25","2020-12-18","2020-02-09","2020-02-09","2020-02-09","2019-03-05","2019-10-03","2022-03-25","2022-03-28","2020-12-18","2021-03-11","2021-03-25","2021-03-25","2022-03-25","2022-03-25","2022-03-25","2019-06-06","2020-06-08","2020-06-08","2020-09-18","2020-06-08","2020-06-08","2021-07-15","2022-03-25","2020-12-18","2022-03-30","2022-03-30","2022-10-15","2022-10-14","2022-10-15","2022-10-15","2022-10-15","2022-10-15"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","60432026415","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00093317431","ALBUTEROL","FAT E","8.5","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","20.00","Select","Select",""],["","65162004710","OXYCODONE","TAB 5MG","6.00","Select","Select",""],["","65162046510","IBUPROFEN","TAB 600MG","60.00","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","20.00","Select","Select",""],["","00185067401","HYDROXYZ","CAP 25MG","60","Select","Select",""],["","59310057922","PROAIR","AER ","8.5","Select","Select",""],["","67877021901","CEPHALEXIN","CAP 500MG","14","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}