{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHIRLEY C SEGAR","gend":1,"add":"CATHERINE WASHINGTON","city":"RICHMOND","state":"VA","zip":232206311,"dob":"1940-08-22","age":"","mstatus":"","insh":11008509,"cliId":"2KN7NA0AJ46","pno":8043533881,"cno":8043531123,"email":"","ename":"","eno":"","pphy":"FAROOQ, MOHAMMAD","ppno":8045411445,"pcpadd":"12712 Bay Hill Drive","pcpcity":"CHESTER","pcpstate":"VA","pcpzip":238362680,"pcpcounty":"","pcpid":"P0142507","pcpname":"BLOOM GERIATRICS LLC","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":["I50.22","I10","E11.3391","E11.3492","E78.5","F32.9","J44.9","F03.90","J96.11","E03.9","E66.01","M19.90","E11.8","F31.81","I25.10","H40.9","M62.81","N18.3","G62.9","M20.41","M20.42","L85.3","R60.9","G58.8","M79.674","M79.675","B35.1","Z79.01","E11.40","E11.9","N18.9","D64.9","E11.21","G47.30","I12.9","N20.0","I50.9","R80.9","R19.8","F33.1","I50.30","E11.22","I48.91","R79.1","S22.39XA","I95.1","R29.6","B36.9","R30.0","N28.9","Z99.81","R82.79","N39.0","N18.4","I25.9","E83.42","K21.9","G47.00","E05.90","I11.9","E11.42","Z11.59","Z20.828","R26.89","I24.9","R53.1","E55.9","R53.83","R63.0","F41.1","R06.02","J18.1","R91.8","U07.1","J96.21","Z79.4","E11.3493","H35.059","H35.371","H35.341","E11.3299","H35.30","E10.39","J12.89","J18.9","E16.2","H57.12","R63.4","K59.00","R26.81","R60.0","H35.033","R26.2","F43.10","R73.09","N18.30","I50.32","Z03.818","Z20.822"],"date":["2020-10-01","2021-02-11","2021-01-05","2021-01-05","2021-02-09","2020-12-28","2021-02-12","2021-02-09","2021-01-05","2020-10-12","2021-01-05","2021-01-05","2020-01-01","2021-01-05","2021-01-05","2021-01-01","2021-02-09","2020-09-14","2020-04-20","2020-10-20","2020-10-20","2020-03-10","2021-01-05","2020-03-10","2020-10-20","2020-10-20","2020-10-20","2020-08-29","2021-02-12","2020-10-09","2020-12-23","2021-01-05","2020-01-22","2020-01-22","2020-08-06","2020-01-22","2021-02-11","2020-01-22","2020-02-03","2020-03-06","2021-01-25","2021-01-11","2020-06-15","2020-08-30","2020-03-19","2020-03-19","2020-03-19","2021-01-01","2020-04-28","2020-09-15","2021-01-21","2020-04-29","2020-05-06","2020-10-12","2021-02-11","2020-06-10","2020-06-22","2020-12-28","2020-06-26","2020-07-13","2020-10-02","2020-07-21","2020-12-22","2021-01-05","2021-01-05","2021-02-12","2021-01-05","2020-09-03","2020-10-19","2019-12-01","2019-09-01","2020-09-09","2020-09-01","2020-09-24","2020-09-14","2021-02-01","2019-10-17","2019-10-17","2019-10-17","2019-09-12","2020-09-14","2019-09-26","2019-09-24","2020-09-24","2020-09-17","2020-09-22","2019-10-08","2020-10-01","2020-10-06","2021-01-05","2020-10-20","2019-10-17","2020-10-20","2021-01-01","2021-01-12","2021-01-25","2020-12-23","2020-12-09","2021-02-12"],"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":""}]}]}