{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ECURBSIRROM","gend":0,"add":"T9 E 513TEERTS H","city":"RICHMOND","state":"VA","zip":"23224-4007","dob":"1956-10-27","age":"","mstatus":"","insh":"81017330","cliId":"","pno":"2940809506","cno":8043504955,"email":"","ename":"","eno":"","pphy":"CAMPBELL, CARA ELIZABETH","ppno":8042923011,"pcpadd":"180 E BELT BLVD,","pcpcity":"Richmond","pcpstate":"VA","pcpzip":"23224-1204","pcpcounty":"","pcpid":"","pcpname":"THE SOUTHSIDE COMMUNITY HEALTH CENTER OF GREATER RICHMOND","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"315 E 9TH STREET","add3":"","madd1":"315 E 9TH STREET","madd2":"","madd3":"","mcity":"RICHMOND","mstate":"VA","mzip":"23224-4007","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B18.2","K74.60","F14.11","F11.11","I10","E78.2","K30","Z23","R73.03","M25.562","G89.29","R39.11","E11.9","Z71.89","Z71.3","M17.12","F32.A","F14.10","F33.2","F14.20","F10.20","Z20.822","R45.851","F41.9","I12.9","N18.30","I95.9","E11.22","E11.65","E78.5","E87.6","F14.90","Z79.4","F43.10","F14.21","F10.21","B35.9","E11.8","Z86.39","K21.9","F17.200","E55.9","R73.9","M75.22","R07.9","F19.10","R00.1","R13.10","K70.30","E78.1","Z12.5","M25.561","Z72.0"],"date":["2023-01-12","2023-03-13","2021-02-26","2021-02-26","2023-03-13","2021-11-02","2021-09-30","2021-09-30","2021-09-30","2022-03-24","2023-01-19","2021-09-30","2021-12-27","2021-11-02","2023-03-13","2021-11-03","2021-12-26","2021-12-26","2022-01-06","2022-01-06","2022-01-06","2021-12-26","2021-12-26","2021-12-26","2021-12-26","2021-12-27","2021-12-26","2021-12-26","2021-12-26","2022-04-28","2021-12-27","2021-12-26","2021-12-26","2022-06-30","2022-03-10","2022-05-12","2022-02-22","2023-03-13","2022-03-24","2023-03-13","2022-04-28","2022-06-30","2023-01-12","2022-03-24","2022-06-30","2022-04-28","2022-05-12","2022-05-12","2023-01-19","2023-01-12","2023-01-12","2023-01-19","2023-03-13"],"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":[["","68462039130","ESOMEPRA MAG","CAP 40MG DR","30","Select","Select",""],["","68180063609","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","59267030402","PFIZER BIVAL","INJ BA4\/BA5","0.3","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":""}]}]}