{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROBIN D ELSWICK","gend":1,"add":"629 ST MARY DRIVE","city":"MINERAL","state":"VA","zip":231179999,"dob":"1957-04-10","age":"","mstatus":"","insh":11008510,"cliId":"1H65F92YW62","pno":5408944618,"cno":5407480497,"email":"","ename":"","eno":"","pphy":"DEN HARTOG, JULIE R","ppno":5406613004,"pcpadd":"661 University Ln","pcpcity":"Orange","pcpstate":"VA","pcpzip":229602243,"pcpcounty":"","pcpid":"P0060357","pcpname":"UNIVERSITY PHYSICIAN ORANGE","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","R30.0","I25.10","E87.6","E11.65","H25.011","H25.012","I10","F41.9","R26.89","R07.2","R07.89","E78.5","K21.9","F32.9","I25.2","Z79.02","Z79.82","Z79.84","R07.9","R94.31","H25.813","Z01.818","H25.811","F41.8","R56.9","H25.812","Z23"],"date":["2020-11-17","2020-02-24","2020-11-17","2020-02-24","2020-02-24","2020-03-16","2020-03-16","2020-09-09","2020-06-10","2020-06-10","2020-09-09","2020-09-09","2020-11-17","2020-09-09","2020-09-09","2020-09-09","2020-09-09","2020-09-09","2020-09-09","2020-09-09","2020-09-09","2020-09-23","2020-10-19","2020-11-03","2020-11-03","2020-11-03","2020-11-17","2019-11-06"],"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":""}]}]}