{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ATTEIKNIFFIRG","gend":1,"add":"     ENAL TOM WODAEM 0033                         ","city":"RICHMOND                 ","state":"VA","zip":"23223-9998","dob":"1989-12-24","age":"","mstatus":"","insh":"10114037","cliId":"","pno":"0943447546","cno":"","email":"","ename":"","eno":"","pphy":"JORDAN-SAYLES, CHERYL D","ppno":8042262444,"pcpadd":"4620 S LABURNUM AVE,","pcpcity":"Henrico","pcpstate":"VA","pcpzip":232312424,"pcpcounty":"","pcpid":"","pcpname":"LABURNUM MEDICAL CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"3300 MEADOW MOT LANE                              ","madd2":"                                                  ","madd3":"","mcity":"RICHMOND                 ","mstate":"VA","mzip":"23223-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F25.1","F25.0","S02.2XXA","R51.9","Y04.0XXA","O26.891","R10.30","O99.341","F41.0","R10.9","F41.9","F17.200","F25.9","Z74.3","O09.90","O26.90","Z04.6","F10.10","E11.9","E78.5","I10","Z13.29","R14.0","R11.0","R53.83","R06.02","Z32.02"," "],"date":["2021-01-11","2021-01-11","2021-01-19","2021-01-19","2021-01-19","2021-02-24","2021-02-24","2021-02-24","2021-02-24","2021-02-24","2021-02-24","2021-02-24","2021-02-24","2022-07-25","2021-08-30","2022-07-25","2022-01-27","2022-01-27","2022-01-27","2022-01-27","2022-01-27","2022-01-27","2022-07-29","2022-07-29","2022-07-29","2022-07-29","2022-07-29","2022-07-29"],"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":[["","65162010250","GABAPENTIN","CAP 300MG","60","Select","Select",""],["","13668021930","ARIPIPRAZOLE","TAB 15MG","30","Select","Select",""],["","43547028111","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","23155050201","HYDROXYZ","TAB 50MG","60","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":""}]}]}