{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" N EDASTTERRAG","gend":1,"add":"XOB OP2621 ","city":"PETERSBURG","state":"VA","zip":"23804-1262","dob":"1990-05-03","age":"","mstatus":"","insh":"90014349","cliId":"","pno":"3940811351","cno":"","email":"","ename":"","eno":"","pphy":"WEST, TRENEE J","ppno":8047962373,"pcpadd":"12901 BRIGGS RD,","pcpcity":"Chester","pcpstate":"VA","pcpzip":"23831-5335","pcpcounty":"","pcpid":"","pcpname":"SOUTHSIDE PHYSICIANS NETWORK-FAMILY MEDICINE","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"PO BOX 1262","add3":"","madd1":"PO BOX 1262","madd2":"","madd3":"","mcity":"PETERSBURG","mstate":"VA","mzip":"23804-1262","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S61.021A","S61.011A","W25.XXXA","I10","F17.210","W22.8XXA","S61.411A","S61.111D","Z48.02","Z23","Z01.419","R87.612","Z68.29","F12.929","R47.9","I63.9","R47.89","I51.7","J40","R07.89","R11.2","R07.9","R50.9","Z20.822","R05.9","F32.2","V09.9XXD","R45.851","R03.0","S80.212D","S80.211D","M25.572","M79.674","M54.9","W19.XXXA","Y93.89","T14.8XXA","F12.90","S80.211A","S80.212A","W18.30XA","X50.1XXA","E66.9","F32.9","M79.671","F33.1","F31.9","R87.610","R87.5","Z11.3","Z00.00","M25.511","Z13.31","Z68.30","Z11.59","Z13.6","G89.29","M75.101","M75.21","M75.111","M19.011"],"date":["2021-01-30","2021-01-30","2021-01-30","2022-05-05","2022-05-05","2021-01-30","2021-01-30","2021-02-08","2021-02-08","2022-05-05","2022-07-22","2021-12-20","2022-07-22","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2022-03-08","2022-03-08","2022-03-08","2022-03-08","2022-03-08","2022-03-08","2022-03-08","2022-03-08","2022-05-07","2022-05-05","2022-05-05","2022-05-06","2022-05-05","2022-05-05","2022-05-06","2022-05-05","2022-05-05","2022-05-05","2022-05-05","2022-05-05","2022-10-12","2022-05-06","2022-05-06","2022-05-05","2022-05-05","2022-10-12","2022-05-06","2022-05-06","2022-06-26","2022-07-10","2022-07-22","2022-07-22","2022-08-30","2022-10-12","2022-11-08","2022-10-12","2022-10-12","2022-10-12","2022-10-12","2022-10-12","2023-01-25","2023-01-25","2022-11-22","2023-01-25"],"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":[["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","16571066401","METRONIDAZOL","TAB 500MG","18","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8.5","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":""}]}]}