{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHRISTINA N HINES","gend":1,"add":"1907  WHITCOMB STREET","city":"RICHMOND","state":"VA","zip":232239999,"dob":"1978-12-22","age":"","mstatus":"","insh":11001414,"cliId":"6V41DU0ME16","pno":8043060210,"cno":8043973816,"email":"","ename":"","eno":"","pphy":"DEBOER, SARAH E","ppno":8047800840,"pcpadd":"719 N 25th St","pcpcity":"Richmond","pcpstate":"VA","pcpzip":232236539,"pcpcounty":"","pcpid":"P9058308","pcpname":"VERNON J HARRIS EAST END COMMUNITY HEALTH CENTER","plan":"VPHP - VIRGINIA PREMIER","program":"Medicare","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["F33.9","F41.1","F25.1","F41.0","F43.10","N97.9","F17.210","Z01.411","F11.20","F33.1","L02.92","Z71.89","F41.9","Z71.3","F31.9","Z68.26","F31.2","F43.12","F25.0","F51.4","R45.89","M77.9","M25.571","M25.579","M79.89","M54.5","Z13.1","Z13.0","Z79.899","Z13.220","M25.871","F29","G47.00","Z72.0","L02.224","R03.0","Z68.25","E78.2","Z11.4","Z12.31","F22","F32.1"],"date":["2020-07-20","2020-11-13","2021-01-15","2020-01-22","2020-07-20","2020-03-10","2020-03-10","2020-03-10","2020-11-13","2020-11-13","2020-07-22","2020-12-07","2020-12-07","2020-12-07","2020-12-07","2020-07-22","2021-02-22","2021-02-22","2021-01-15","2020-11-19","2021-01-15","2019-08-12","2019-11-04","2019-08-12","2019-08-12","2019-08-23","2019-08-23","2019-08-23","2020-12-07","2019-08-23","2019-11-04","2021-01-15","2020-11-13","2020-11-13","2020-12-07","2020-12-07","2020-12-07","2020-12-07","2020-12-07","2020-12-07","2021-01-15","2021-02-02"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"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":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}