{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"OR R AIRAMZERROT SAJ","gend":1,"add":"AM W 1201TEERTS NI","city":"BERRYVILLE","state":"VA","zip":"22611-3507","dob":"1969-10-25","age":"","mstatus":"","insh":"02016811","cliId":"","pno":"0217565111","cno":"","email":"","ename":"","eno":"","pphy":"IDREES, IRFAN","ppno":5403380032,"pcpadd":"200 N MAPLE AVE,","pcpcity":"Purcellville","pcpstate":"VA","pcpzip":"20132-6100","pcpcounty":"","pcpid":"","pcpname":"LOUDOUN MEDICAL GROUP","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"1021 W MAIN STREET","add3":"","madd1":"1021 W MAIN STREET","madd2":"","madd3":"","mcity":"BERRYVILLE","mstate":"VA","mzip":"22611-3507","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["ASIAN\/PACIFIC"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.9","Z79.899","L20.84","G89.4","M25.50","M06.9","Z79.891","R05","F17.218","I10","F41.9","R03.0","N39.3","R53.83","Z12.39","Z12.11","J20.9","Z72.0","M06.00","M19.049","N39.41","Z68.21","Z23","R00.2","R07.9","R21","B02.9","F17.210","R20.9","J06.9","R50.9","R05.9","R15.1","K62.89","R19.7","R15.9","R10.9","J98.4","R05.3","J44.9","L74.519","R11.0","Z01.30","E86.0","Z20.822","R89.9","T78.40XA","L29.9","K29.70","R10.13","J18.9","R06.02","R91.1","F17.200","J47.9","R91.8","J47.1","Z09","R07.89","R61","R39.16","N39.46","R39.198","R42","M19.90","M54.50"],"date":["2022-06-09","2022-12-20","2023-01-03","2023-04-24","2023-01-25","2023-01-25","2023-01-25","2021-02-01","2021-02-01","2023-01-31","2021-04-28","2022-09-29","2023-04-11","2022-07-26","2021-05-24","2021-05-24","2022-11-16","2021-06-03","2023-04-13","2022-12-22","2023-04-11","2021-10-07","2022-12-20","2021-12-02","2023-02-23","2022-07-26","2022-02-09","2022-09-29","2022-02-09","2022-11-20","2022-11-16","2022-11-20","2022-05-13","2022-05-13","2022-05-13","2022-05-13","2022-10-04","2022-11-21","2022-06-13","2022-12-20","2022-06-27","2023-04-05","2022-07-19","2022-07-19","2022-09-29","2022-07-19","2022-07-26","2023-01-03","2022-08-14","2022-08-23","2022-11-20","2022-11-11","2022-11-17","2022-11-17","2022-11-17","2022-11-17","2022-11-21","2022-12-20","2022-12-20","2023-04-14","2023-03-14","2023-03-14","2023-03-14","2023-04-05","2023-04-05","2023-04-24"],"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":[]},{"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":""}]}]}