{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"S ACISSEJDLEIFREH","gend":1,"add":"ALDOOW827EUNEVA DN","city":"WINCHESTER","state":"VA","zip":"22601-5617","dob":"1979-05-24","age":"","mstatus":"","insh":"4544577","cliId":"","pno":"6604539474","cno":"","email":"","ename":"","eno":"","pphy":"KAISER, SHERIF","ppno":5409554811,"pcpadd":"115 S CHURCH ST,","pcpcity":"Berryville","pcpstate":"VA","pcpzip":"22611-1369","pcpcounty":"","pcpid":"","pcpname":"BERRYVILLE MEDICAL ASSOCIATES PLC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"728WOODLAND AVENUE","add3":"","madd1":"728WOODLAND AVENUE","madd2":"","madd3":"","mcity":"WINCHESTER","mstate":"VA","mzip":"22601-5617","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","F10.20","F41.0","F32.9","G60.0","B19.20","F31.9","F41.9","R68.89","E11.9","R53.1","R42","D64.9","Z00.00","G62.9","R20.2","R00.2","F32.0","B18.2","E78.81","F41.1","G47.00","G60.9","F43.10","F17.200","E53.8","E55.9","R03.0","Z23","R05","R09.81","B34.9","Z20.828","N39.0","N89.8","Z20.2"],"date":["2023-05-24","2021-05-14","2021-05-14","2021-05-14","2021-02-08","2021-02-08","2021-04-08","2021-05-06","2021-02-04","2021-02-08","2021-02-08","2021-02-08","2021-02-08","2021-08-24","2021-02-25","2021-02-25","2021-05-06","2021-05-06","2022-07-06","2022-07-06","2022-07-06","2022-07-06","2022-07-06","2022-07-06","2022-07-06","2022-07-06","2022-07-06","2021-06-03","2021-06-03","2021-06-17","2021-06-17","2021-06-17","2021-06-17","2022-07-06","2022-04-24","2022-04-24"],"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":""}]}]}