{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BEULAH J SPRUILL","gend":1,"add":"606 PHOEBUS SQUARE","city":"PORTSMOUTH","state":"VA","zip":237049999,"dob":"1941-12-30","age":"","mstatus":"","insh":11008856,"cliId":"8YD0GK6DE44","pno":7579679880,"cno":"","email":"","ename":"","eno":"","pphy":"HUMADI, SAHIRA A","ppno":7574465955,"pcpadd":"1701 High St","pcpcity":"Portsmouth","pcpstate":"VA","pcpzip":237043103,"pcpcounty":"","pcpid":"P9058629","pcpname":"EVMS MEDICAL GROUP","plan":"VPHP - VIRGINIA PREMIER","program":"Medicare","lob":"DSNP","region":"TIDEWATER","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":["R10.13","K59.00","R63.4","N83.209","M17.12","M25.562","G89.29","K29.50","R93.3","K31.1","K21.9","K57.30","J45.909","Z79.899","Z79.51","Z88.8","Z68.1","R68.81","T78.40XA","R93.5","N28.1","M17.0","R60.0","M54.5","R26.81","I26.99","M48.54XA","M19.90","J45.20","R10.9","K31.89","R07.9","S22.070A","K29.70","M54.9","I34.0","I82.403","S22.070D","M81.0","W19.XXXD","M62.830","M25.512","K04.7","K14.8","J32.9","K02.9","Z79.01","M25.561","R54","R64","R26.2","M23.51","M23.52","S22.42XA","Z20.828","Z87.39","R20.8","R10.84","R06.02","R00.0","M85.80","N20.0","K44.9","I51.3","Z86.711","R10.30","S22.000A","I26.09","I23.6","S22.080D","I48.91","Z09","I08.0","I51.7","M17.11","Z68.20","R19.09","N83.8","E83.52","Z87.81","Z78.0","R35.8","S22.42XD","Q40.0","N83.202","Z92.29","R63.0"],"date":["2021-02-12","2020-08-26","2020-08-26","2020-08-26","2020-01-17","2020-12-10","2020-09-17","2020-03-02","2020-07-08","2020-07-29","2020-11-08","2020-02-28","2020-07-29","2020-04-21","2020-02-28","2020-09-17","2020-12-08","2020-02-28","2020-04-21","2020-05-05","2020-05-05","2020-12-10","2020-07-02","2020-12-10","2020-07-02","2021-02-12","2020-09-17","2020-09-17","2020-11-08","2020-06-22","2020-06-25","2020-06-22","2020-06-25","2020-07-29","2020-09-17","2020-06-23","2020-06-23","2020-07-29","2021-02-10","2020-07-29","2020-07-29","2020-11-08","2020-07-29","2020-07-29","2020-07-29","2020-07-29","2020-11-08","2020-12-10","2020-09-17","2020-07-02","2020-12-10","2020-12-10","2020-12-10","2020-09-16","2020-09-17","2020-09-16","2020-09-16","2020-09-16","2020-09-17","2020-11-08","2020-11-08","2020-11-08","2020-11-08","2020-11-18","2020-09-17","2020-10-16","2020-10-16","2020-10-09","2020-10-09","2020-11-08","2020-10-19","2020-10-26","2020-11-18","2020-11-18","2019-12-09","2019-11-25","2019-12-26","2019-12-26","2021-02-10","2021-01-14","2021-02-10","2021-02-12","2020-11-08","2020-11-08","2020-12-08","2020-12-08","2020-12-08"],"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":""}]}]}