{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"REHTAEHLLAH N ","gend":1,"add":"RAHCRO 05433DAOR LLIH D","city":"DAMASCUS","state":"VA","zip":"24236-2713","dob":"1988-08-09","age":"","mstatus":"","insh":"10114985","cliId":"","pno":"5467252811","cno":"","email":"","ename":"","eno":"","pphy":"BURT, JACQUELYN C","ppno":2764694200,"pcpadd":"349 ISLAND RD, ","pcpcity":"Bristol","pcpstate":"VA","pcpzip":242017009,"pcpcounty":"","pcpid":"","pcpname":"WELLMONT MEDICAL ASSOCIATES INC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"33450 ORCHARD HILL ROAD","madd2":"","madd3":"","mcity":"DAMASCUS","mstate":"VA","mzip":"24236-2713","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C81.11","Z94.84","Z79.899","Z85.71","R10.9","N91.1","R19.7","R39.9","R31.9","C81.90","R05.9","R09.81","B34.9","J01.00","G62.0","T45.1X5A","F41.1","J30.2","N91.2","Z01.411","Z30.431","Z12.4","Z68.37","R68.89","C81.70","R42","F41.9","E66.9","R00.0","G25.81","J06.9","R06.2","R05","Z20.828","N89.8","Z20.2","Z87.42"],"date":["2021-01-05","2021-09-07","2021-09-07","2021-01-05","2021-01-11","2021-01-11","2021-01-11","2021-12-15","2021-01-11","2021-09-15","2022-02-10","2022-02-10","2022-02-10","2022-02-14","2021-09-15","2021-09-15","2021-04-09","2021-04-09","2021-04-14","2021-04-14","2021-04-14","2021-04-14","2021-04-14","2021-05-21","2021-09-07","2021-09-09","2021-09-09","2021-09-09","2021-09-09","2021-09-15","2020-12-09","2020-12-09","2020-12-09","2020-12-09","2021-12-15","2021-12-15","2021-12-15"],"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":[]}},{"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":""}]}]}