{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HPESOJYRAG ","gend":0,"add":"uaC 9193tC redl","city":"Richmond","state":"VA","zip":"23224-5034","dob":"1953-06-02","age":"","mstatus":"","insh":"00119996","cliId":"","pno":"5240803732","cno":"","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":"                                                  ","add3":"","madd1":"3919 Caulder Ct","madd2":"                                                  ","madd3":"","mcity":"Richmond","mstate":"VA","mzip":"23224-5034","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","R89.9","Z92.29","F33.3","F33.2","F32.3","Z20.822","F33.0","F14.20","R79.89","R79.9","R68.89","E55.9","E53.8","R35.1","F32.9","Z79.899","H93.299","R97.20","F32.0","F33.9","F41.1","F31.9","F31.0","I10","R06.02","Z13.31","I11.9","R94.31","H53.8","K76.9","C22.0","K66.1","J43.9","K76.89","K82.8","K57.30","K42.9","F17.200","R59.0"],"date":["2022-04-27","2021-06-18","2021-06-18","2020-09-15","2020-12-28","2021-09-27","2022-06-19","2020-06-14","2020-01-03","2021-06-18","2021-06-18","2021-06-18","2021-06-18","2021-06-18","2021-06-18","2021-06-18","2021-06-18","2021-06-18","2021-10-06","2020-05-07","2020-07-05","2020-08-24","2020-09-16","2020-04-01","2021-06-18","2021-06-18","2021-06-18","2021-06-18","2021-06-18","2021-06-18","2022-07-11","2022-08-24","2022-06-19","2022-06-19","2022-06-21","2022-06-19","2022-06-19","2022-06-19","2022-06-19","2022-06-21"],"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":[["","00006483703","PNEUMOVAX","INJ 25\/0.5","0.5","Select","Select",""],["","70461012103","FLUAD","INJ 2021-22","0.5","Select","Select",""],["","10702001250","HYDROXYZ","TAB 50MG","90","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","30","Select","Select",""],["","13668013601","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0.25","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}