{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"M   ROVERTKCAMROCCM ","gend":0,"add":"LCRIC EVORG ELLIVREMOS   10521                             E","city":"MIDLOTHIAN                    ","state":"VA","zip":"23114-3121","dob":"1994-07-27","age":"","mstatus":"","insh":"30014830","cliId":"","pno":"4240885345","cno":8042452734,"email":"","ename":"","eno":"","pphy":"UNKNOWN PROVIDER QNXT PCP","ppno":"","pcpadd":"UNKNOWN STREET","pcpcity":"RICHMOND                      ","pcpstate":"VA","pcpzip":232190000,"pcpcounty":"","pcpid":"P0059512","pcpname":"UNKNOWN PROVIDER QNXT PCP","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"12501   SOMERVILLE GROVE CIRCLE                             ","madd2":"                                                            ","madd3":"","mcity":"MIDLOTHIAN                    ","mstate":"VA","mzip":"23114-3121","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F25.0","F41.1","R74.8","E55.9","E66.01","F31.31","Z51.81","Z68.41","F33.2","F31.9","G93.40","E86.0","N17.9","R00.0","I12.9","N18.2","E03.9","Z79.899","Z82.49","Z83.3","Z83.49","F41.9","I10","R41.82","L98.8","R69","F32.1","F31.30","L72.0","E78.2","Z68.42","E78.49","E83.52","E83.51","F20.0","F31.81","R45.851","Z20.822","Z79.890","R45.89","F39","S51.832A","F31.32"],"date":["2021-09-21","2021-11-08","2019-01-04","2019-01-04","2021-10-14","2021-10-27","2019-01-04","2021-10-14","2019-09-08","2021-11-08","2019-03-07","2019-03-06","2019-03-06","2021-11-14","2019-03-06","2021-11-16","2021-10-14","2021-10-14","2019-03-06","2019-03-06","2019-03-06","2019-03-06","2019-03-06","2019-03-07","2019-03-13","2019-09-24","2021-11-14","2021-09-03","2020-09-04","2021-10-14","2021-09-03","2021-09-03","2021-09-03","2021-07-29","2021-11-08","2021-10-14","2021-10-14","2021-10-14","2021-10-14","2021-10-14","2021-10-14","2021-11-14","2021-11-16"],"priorHcc":["",null,"","",null,null,"",null,"",null,"","","",null,"",null,null,null,"","","","","","","","",null,"","",null,"","","","",null,null,null,null,null,null,null,null,null]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}