{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CATHERINE E ROSS","gend":1,"add":"1337 CARLTON AVENUE","city":"CHARLOTTESVILLE","state":"VA","zip":229029999,"dob":"1953-01-02","age":"","mstatus":"","insh":11008928,"cliId":"6XC1KP3DR03","pno":4348253855,"cno":4349958044,"email":"","ename":"","eno":"","pphy":"VOSS, CAROL","ppno":5403700295,"pcpadd":"11 Smokehouse Dr Ste 101","pcpcity":"Fredericksburg","pcpstate":"VA","pcpzip":224068455,"pcpcounty":"","pcpid":"P9120180","pcpname":"MARY WASHINGTON HEALTHCARE PHYSICIANS","plan":"VPHP - VIRGINIA PREMIER","program":"Medicare","lob":"DSNP","region":"WESTERN\/CHARLOTTESVILLE","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","I21.4","I10","I50.23","E11.3293","H25.043","H40.013","M10.012","M10.031","M79.643","M10.032","N39.490","N18.9","E11.9","E11.22","Z79.4","N18.4","E89.0","E11.59","K59.04","I11.0","I25.10","I45.10","E78.5","I13.0","G47.33","E03.9","Z95.810","M10.9","F31.9","Z79.82","Z95.5","I12.9","E11.65","M62.81","M79.675","R52","Z74.3","R60.0","R06.02","M10.072","M1A.3710","R26.81","E05.00","M1A.3410","M1A.3420","K75.81","E11.40","M17.12","E11.610","E11.8","M19.072","M19.071","M25.572","M25.571","M25.579","S99.912A","M25.561","M17.11","M25.461","G89.29","E66.01","Z68.41","M65.9","M25.562","I13.2","G92","N17.9","E87.4","E87.1","I42.8","I25.2","H40.9","I65.29","I69.30","K59.00","K74.60","L89.151","I50.21","I51.7","J81.1","I42.9","K76.1","M1A.9XX0","I50.89","N18.3","R90.89","R29.818","I45.81","R29.810","R47.1","R20.0","R56.9","I65.23","I69.314","R40.4","E87.70","G93.49","R20.2","Z99.2","E87.79","R41.0","D64.9","R19.7","G47.30","G93.40","Z45.2","T82.328A","R11.10","E87.2","E87.5","E11.42","E16.0","T38.3X5A","N18.6","I50.20","Z49.31","I25.5","F33.9","D50.8","I63.9","R41.82","R50.9","R94.5","A41.9","R65.21","T80.211A","Y84.8","A41.01","G93.41","A41.59","I27.22","Z13.6","R78.81","I27.20","B95.61","T82.7XXA","I77.89","T80.219A","A49.01","B96.89","N18.30","R26.2","I27.0","M25.469","Z23","R79.89","R79.9","Z88.5","N18.32","D84.9","E11.319","J81.0","M79.89","I50.9","M79.604","I33.0","M79.661","R22.41","I20.8","R07.9","Z51.5","Z71.89","D63.1","N25.81","T82.7XXD","M70.42","T82.49XA","M25.531","S63.501A","W50.0XXA","S63.501D","X58.XXXD","M19.041","S69.91XS","M79.644","N18.5","E11.21","E66.9","R53.1","E78.00","Z96.661","Z87.891","Z79.899","Z79.890","N28.9","Z49.01","Z20.822","Z66","J44.9","J44.1","Z86.14","R77.8","Z68.35","K21.9","H35.362","H35.61","H40.1131","T82.898A"],"date":["2021-02-15","2021-01-22","2021-01-22","2021-02-03","2021-02-16","2020-02-11","2020-02-11","2020-02-27","2020-02-27","2020-02-27","2020-02-27","2020-07-27","2021-01-31","2021-01-28","2021-01-27","2021-01-28","2021-02-15","2020-09-15","2020-03-16","2020-03-16","2021-01-27","2021-02-03","2020-08-29","2021-02-03","2021-02-03","2021-01-27","2021-01-27","2020-10-29","2021-02-03","2021-02-03","2021-01-07","2021-01-27","2021-02-15","2021-01-27","2020-10-23","2020-06-19","2020-11-13","2021-01-27","2020-11-13","2021-01-27","2020-06-21","2020-07-29","2020-07-29","2021-02-03","2020-07-29","2020-07-29","2020-09-24","2020-10-23","2020-07-29","2020-07-08","2020-07-08","2020-07-08","2020-07-08","2020-07-08","2020-10-29","2020-07-08","2020-07-08","2020-08-14","2020-08-14","2020-07-14","2020-07-14","2020-10-27","2020-10-27","2020-08-14","2020-08-14","2021-02-03","2020-08-21","2021-02-15","2020-08-21","2020-09-24","2021-02-03","2021-02-03","2021-01-27","2020-08-21","2020-10-23","2020-09-23","2020-08-21","2020-10-23","2020-10-26","2021-01-27","2021-01-27","2021-02-01","2020-08-24","2020-08-24","2020-08-28","2020-09-23","2020-08-28","2020-08-28","2020-08-29","2020-08-29","2020-08-29","2020-08-29","2020-08-30","2020-08-30","2020-08-30","2020-09-05","2020-11-28","2020-09-07","2020-09-06","2021-02-03","2021-02-01","2020-09-21","2021-01-01","2020-10-08","2020-09-08","2020-10-27","2021-01-25","2020-09-12","2020-09-13","2020-09-24","2020-10-27","2020-10-27","2020-09-15","2020-09-15","2021-02-04","2020-10-29","2020-10-23","2020-11-13","2020-09-23","2020-09-23","2020-09-23","2020-11-30","2020-09-23","2020-09-23","2020-09-25","2020-09-28","2020-09-24","2020-09-24","2020-09-28","2020-10-23","2020-09-24","2020-10-27","2020-09-24","2020-10-29","2021-02-03","2020-10-29","2020-10-05","2020-10-02","2020-10-08","2020-10-29","2020-10-23","2020-10-29","2021-02-03","2020-10-23","2020-10-16","2019-10-17","2020-10-22","2020-10-23","2021-01-07","2020-10-26","2020-10-27","2021-01-27","2020-10-27","2020-10-27","2021-02-08","2020-10-28","2020-11-30","2020-10-30","2020-10-30","2019-11-08","2019-11-11","2020-11-13","2020-11-13","2020-11-26","2020-11-26","2020-11-30","2019-12-10","2020-12-17","2019-12-18","2019-12-18","2019-12-18","2019-12-18","2019-12-18","2019-12-24","2019-12-24","2019-12-24","2021-01-01","2021-02-15","2021-02-03","2021-02-03","2021-01-07","2021-01-07","2021-01-07","2021-01-07","2021-01-07","2021-01-17","2021-01-25","2021-01-27","2021-01-27","2021-01-27","2021-01-27","2021-01-31","2021-02-01","2021-02-03","2021-02-03","2021-02-16","2021-02-16","2021-02-16","2020-12-26"],"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":""}]}]}