{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"R ENOMISRELLIM ","gend":1,"add":"SYRAM 0334DAOR ELLIV","city":"ALTAVISTA","state":"VA","zip":"24517-4156","dob":"1990-02-15","age":"","mstatus":"","insh":"3718808","cliId":"","pno":"3543425424","cno":"","email":"","ename":"","eno":"","pphy":"TUCKER, MELISSA","ppno":4343091165,"pcpadd":"1280A MAIN ST,","pcpcity":"Altavista","pcpstate":"VA","pcpzip":"24517-1465","pcpcounty":"","pcpid":"","pcpname":"CENTRA MEDICAL GROUP","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"4330 MARYSVILLE ROAD","add3":"","madd1":"4330 MARYSVILLE ROAD","madd2":"","madd3":"","mcity":"ALTAVISTA","mstate":"VA","mzip":"24517-4156","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.69","E11.9","E55.9","Z23","E78.5","K59.00","F41.9","Z78.9","Z68.42","E66.01","R45.89","Z13.31","Z01.419","Z30.9","Z12.4","Z11.51","R51.9","Z79.84","U07.1","Z11.59","D64.9","F33.1","E28.2","D50.9","D50.0","Z83.79","N92.0","Z51.11","F32.9","R07.9"],"date":["2022-10-14","2022-10-14","2022-10-14","2022-10-14","2022-10-14","2021-01-20","2022-02-09","2021-07-21","2022-10-14","2022-10-14","2021-01-20","2021-01-20","2021-04-20","2021-04-20","2021-04-20","2021-04-20","2021-07-21","2022-10-14","2022-01-31","2022-02-09","2022-02-09","2022-10-14","2022-03-08","2022-02-11","2022-08-26","2022-03-08","2022-03-17","2022-03-24","2022-10-14","2022-10-14"],"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":""}]}]}