{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SELRAHCENAOR ","gend":0,"add":"   TEERTS NOTGNILLEW 4133                         ","city":"RICHMOND                 ","state":"VA","zip":"23222-2850","dob":"1939-10-04","age":"","mstatus":"","insh":"00118139","cliId":"","pno":"2940820590","cno":"","email":"","ename":"","eno":"","pphy":"CZAJKOWSKIIII, STANLEY","ppno":8047641253,"pcpadd":"8220 MEADOWBRIDGE RD,  STE 306","pcpcity":"Mechanicsville","pcpstate":"VA","pcpzip":231162341,"pcpcounty":"","pcpid":"","pcpname":"BON SECOURS MEMORIAL REGIONAL MEDICAL CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"3314 WELLINGTON STREET                            ","madd2":"                                                  ","madd3":"","mcity":"RICHMOND                 ","mstate":"VA","mzip":"23222-2850","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R53.81","Z00.00","Z68.24","R03.0","Z13.5","Z23","Z13.31","D64.9","N18.30","E78.2","G31.84","R73.03","N40.1","R35.1","R19.5","D12.0","D12.3","K57.30","K92.1","F01.50","H10.32","Z01.812","Z20.828","K63.5","K57.90","Z68.25","K64.1","M19.90","Z87.891","Z79.899","R05","R68.89","N18.3","D63.8"],"date":["2022-07-25","2022-05-13","2020-02-25","2020-09-24","2020-02-25","2020-02-25","2020-02-25","2022-05-13","2022-05-13","2022-05-13","2022-05-13","2022-05-13","2022-05-13","2022-05-13","2020-08-17","2020-08-17","2020-08-17","2020-08-17","2020-08-17","2021-04-29","2021-04-29","2020-08-13","2020-08-13","2020-08-17","2020-08-17","2022-05-13","2020-08-17","2020-08-17","2020-08-17","2020-08-17","2020-08-22","2020-09-24","2020-09-24","2020-09-24"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","13668010390","DONEPEZIL","TAB 10MG","90","Select","Select",""],["","70461012003","FLUAD","INJ 0.5ML","0.5","Select","Select",""],["","52268001201","SUPREP","SOL PREP KIT","354","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":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"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":""}]}]}