{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  AYUAHCATSNIKDA C ","gend":1,"add":"AWALLAC 952H TPA NL Y","city":"FARMVILLE","state":"VA","zip":"23901-9998","dob":"1998-08-27","age":"","mstatus":"","insh":"3493510*14","cliId":"","pno":"75\/4346725-4","cno":"804\/245-7835","email":"","ename":"","eno":"","pphy":"PARR, KIMBERLY NP","ppno":"434\/200-3908","pcpadd":"125 NATIONWIDE DR","pcpcity":"LYNCHBURG","pcpstate":"VA","pcpzip":24502,"pcpcounty":"","pcpid":"","pcpname":"CENTRA MEDICAL GROUP LLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O26.899","P81.9","L22.","Z05.1","R10.31","R19.7","R11.0","Z87.891","T59.91XA","Z20.828","S39.012A","R07.89","B37.3","R31.29","R82.90","K21.9","R10.13","Z34.82","Z71.89","Z71.3","O98.511","J02.9","B34.9","Z3A.13","Z34.83","F32.9","Z79.899","R00.0","R30.0","O34.219","O99.824","Z37.0","Z3A.39","R11.10","K04.7","Z88.0","J02.0","R07.0","N39.0","O22.41","Z3A.11","Z3A.00","Z30.42","H66.91","Z20.822","R39.9","N92.0","R10.9","R53.83","K52.9","I88.0","Z23.","O34.211","D62.","O98.32","A59.01","O99.02","Z83.3","Z82.49","R82.998","Z88.1","Z34.02","R10.84","A74.9","N76.0","B96.89","N93.9","Z11.3","H66.92","A05.8","N30.90","R10.30","S93.401A","X50.1XXA","Y92.89"],"date":["2019-07-21","2019-08-12","2019-08-12","2019-08-12","2020-07-19","2020-07-19","2020-07-19","2021-12-09","2020-11-04","2020-11-04","2021-02-24","2021-02-24","2021-02-24","2021-03-23","2021-03-23","2021-12-09","2021-12-09","2019-05-10","2019-05-22","2019-05-22","2019-02-10","2019-02-10","2021-09-20","2019-02-10","2019-05-22","2020-07-30","2020-07-30","2021-02-12","2021-11-12","2019-08-05","2019-08-05","2019-08-05","2019-08-05","2020-02-10","2020-12-02","2021-09-20","2021-01-29","2021-09-20","2021-07-13","2019-02-03","2019-02-03","2019-08-05","2019-09-17","2021-09-20","2021-09-20","2021-10-19","2021-11-20","2021-11-20","2021-11-20","2021-05-14","2021-10-04","2019-05-10","2019-08-04","2019-08-04","2019-08-04","2019-08-04","2019-08-04","2019-08-04","2019-08-04","2021-03-23","2021-06-05","2019-02-22","2019-07-16","2020-02-10","2020-04-01","2020-04-01","2020-04-01","2021-03-31","2021-06-05","2021-01-21","2021-02-12","2021-02-12","2021-07-17","2021-07-17","2021-07-17"],"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":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":""}]}]}