{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WILLIAM W HENDERSON JR","gend":0,"add":"218 MARTIN FARM RD","city":"STUART","state":"VA","zip":241719999,"dob":"1952-09-19","age":"","mstatus":"","insh":11007261,"cliId":"1VN5M96PM68","pno":7273481064,"cno":"","email":"","ename":"","eno":"","pphy":"COLE, RICHARD C","ppno":2766944466,"pcpadd":"18877 JEB STUART HWY","pcpcity":"STUART","pcpstate":"VA","pcpzip":241711019,"pcpcounty":"PATRICK","pcpid":"P0123924","pcpname":"PIONEER HEALTH SERVICES OF PATRICK COUNTY","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":["E11.9","R39.81","R15.9","N39.41","E11.69","E66.01","E78.5","I10","J44.9","Z00.01","Z12.5","M51.37","M16.7","F33.9","F02.80","M25.511","R53.1","Z74.09","R05","M25.561","J44.1","M51.36","Z71.6","M54.32","L60.0","L03.031","E10.49","L84","B35.1","M79.674","M79.675","E11.65","R69","L60.2","Z23","M54.17","V49.50XA","Y92.9","M25.552","M79.605","F17.210","M25.512","R10.2","S20.211A","N18.3","M54.42","R07.89","M48.061","N28.1","R91.1","M51.17","M47.817","K12.0"],"date":["2020-12-14","2020-12-23","2020-12-23","2020-12-23","2020-11-24","2020-11-24","2020-02-24","2020-11-24","2020-08-24","2020-02-24","2020-02-24","2020-11-24","2020-01-27","2020-06-25","2020-02-24","2020-03-17","2020-03-17","2020-03-17","2020-04-04","2020-04-04","2019-07-07","2019-11-15","2019-05-14","2020-06-08","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-06-25","2020-12-01","2020-09-08","2019-10-07","2019-10-19","2019-10-22","2019-10-22","2019-10-22","2019-10-22","2019-10-22","2019-10-22","2019-10-22","2019-10-24","2019-11-05","2019-11-15","2019-11-15","2019-11-15","2019-11-15","2019-11-15","2019-11-15","2019-12-30","2019-12-30"],"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","",""],["Yes","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":""}]}]}