{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   YBURNWORB E","gend":1,"add":"            ENAL ELKNERPS 6224                              ","city":"HENRICO                       ","state":"VA","zip":"23228-3614","dob":"1973-11-25","age":"","mstatus":"","insh":"40014358","cliId":"","pno":"3940821128","cno":"","email":"","ename":"","eno":"","pphy":"VCU CENTER FOR ADVANCED HEALTH                              ","ppno":"","pcpadd":"MCV Physicians,2116 W Laburnum Ave Ste 100","pcpcity":"Richmond                      ","pcpstate":"VA","pcpzip":232274359,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"4226 SPRENKLE LANE","madd2":"                                                            ","madd3":"","mcity":"HENRICO                       ","mstate":"VA","mzip":"23228-3614","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E05.00","E87.6","E66.3","R03.0","Z68.31","Z94.7","H52.7","H18.601","Z12.31","Z23","Z13.220","Z13.0","Z00.00","Z76.89","Z01.419","Z11.51","E05.90","N95.1","H18.602","Z68.28","F70","F90.0","F79","R41.840","R41.9","B35.1","Z79.899","E78.2","H18.603","H52.13"],"date":["2021-12-06","2021-07-28","2021-07-28","2021-07-28","2020-02-12","2021-12-17","2021-06-18","2021-06-18","2021-06-11","2021-12-06","2021-01-29","2021-01-29","2021-01-29","2021-01-29","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-06-18","2021-12-06","2021-09-13","2021-12-06","2021-12-06","2021-09-13","2021-09-13","2021-10-01","2021-09-29","2021-12-06","2021-12-17","2021-12-17"],"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":[["","49884064001","METHIMAZOLE","TAB 5MG","1","Select","Select",""],["","69097073102","TERBINAFINE","TAB 250MG","7","Select","Select",""],["","24208072002","DEXAMETH","SOL 0.1% OP","5","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0.3","Select","Select",""],["","49281042050","FLUZONE","INJ 2020-21","0.5","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":""}]}]}