{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"STELLA M DELBRIDGE","gend":1,"add":"MARTHA LEE","city":"COLONIAL HEIGHTS","state":"VA","zip":238342742,"dob":"1940-04-06","age":"","mstatus":"","insh":11004498,"cliId":"7AC2X05TW87","pno":8045268711,"cno":8045266851,"email":"","ename":"","eno":"","pphy":"LEWIS, JOHN W","ppno":8045205580,"pcpadd":"436 CLAIRMONT COURT","pcpcity":"COLONIAL HEIGHTS","pcpstate":"VA","pcpzip":238340000,"pcpcounty":"COLONIAL HEIGHTS CITY","pcpid":"P9409757","pcpname":"SOUTHSIDE PRIMARY CARE PLUS","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":["S72.002D","D64.9","E87.6","F33.9","G47.00","I50.31","J18.9","M62.81","R06.00","R26.2","S72.92XA","D50.9","R60.9","R68.89","R29.898","H91.90","R41.841","F03.90","R05","J30.9","Z98.890","L98.9","F32.9","I50.32","F41.9","Z87.891","Z87.440","H10.33","R52","E53.8","E87.0","R74.8","R03.0","R60.0","I50.9","E55.9","Z78.0","I95.9","R26.89","M25.551","M54.5","W01.0XXA","M89.9","M25.559","M25.652","R11.0","I25.10","I10","E78.5","E61.2","E11.9","R94.6","E03.9","B07.9","Z51.89","M79.605","R26.81","R42","R10.9","R51","B07.8","R07.9","L29.9","R21","S72.142A","R06.02","S72.002A","G89.11","M25.552","D62","E83.51","I95.2","Z23","R09.02","J96.01","N17.9","M16.9","D61.818","N39.0","E86.0","B96.20","R79.1","I26.99","I82.409","Z03.89","K80.20","K83.8","R51.9","L03.811","F41.1","F33.8","S72.009D","M79.662","R53.81","M54.9","S39.92XA","S39.93XA","W19.XXXA","S09.90XA","S01.01XA","S30.0XXA","R29.6","K21.9","K59.00","T14.8XXA","U07.1"],"date":["2019-01-12","2021-01-06","2020-12-09","2021-02-01","2019-01-01","2021-02-01","2019-01-01","2020-11-12","2021-02-01","2020-11-12","2019-01-01","2021-02-01","2021-02-01","2021-02-01","2020-03-01","2021-02-01","2021-02-01","2021-02-01","2019-01-07","2019-01-08","2019-01-11","2019-01-11","2021-01-26","2019-01-12","2019-01-12","2019-01-12","2019-01-12","2020-01-30","2020-01-31","2019-02-22","2019-02-22","2019-02-22","2019-04-05","2021-01-28","2021-01-28","2019-06-12","2019-04-05","2021-01-20","2021-01-26","2019-04-10","2019-04-10","2019-04-10","2019-04-10","2019-04-10","2019-04-10","2020-07-09","2021-02-01","2019-06-12","2019-06-12","2019-06-12","2019-06-12","2019-06-14","2019-06-15","2020-06-15","2020-06-19","2020-06-19","2020-06-19","2019-06-27","2020-07-09","2020-07-27","2020-10-14","2018-10-01","2020-09-28","2020-09-28","2018-10-08","2018-10-14","2018-10-01","2018-12-27","2018-12-07","2018-10-01","2018-10-01","2018-10-01","2018-10-01","2018-10-13","2018-10-21","2018-10-13","2018-10-13","2018-10-13","2018-11-02","2018-10-13","2018-10-21","2018-10-13","2018-10-14","2018-10-14","2018-10-14","2018-10-15","2018-10-15","2020-10-22","2020-10-22","2018-12-26","2018-11-05","2018-11-21","2018-11-21","2018-11-14","2018-11-09","2018-11-09","2018-11-09","2018-11-09","2018-11-09","2018-11-09","2018-11-09","2018-12-30","2018-12-06","2019-11-25","2018-12-01","2021-02-01"],"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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}