{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MAXCINE W FLEMING","gend":1,"add":"3900 PLANK ROAD","city":"FREDERICKSBURG","state":"VA","zip":224079999,"dob":"1928-07-15","age":"","mstatus":"","insh":11010948,"cliId":"7NX7MX8AD79","pno":5402467500,"cno":5402873553,"email":"","ename":"","eno":"","pphy":"AHMAD, NAEEM","ppno":5403683700,"pcpadd":"4510 Plank Rd","pcpcity":"Fredericksburg","pcpstate":"VA","pcpzip":224070138,"pcpcounty":"","pcpid":"P0114067","pcpname":"PRIMARY AND URGENT CARE 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":["G30.9","I69.30","M62.81","R26.2","R13.10","Z90.12","I10","R41.841","R41.89","R52","Z87.440","I63.9","E78.5","E03.9","D64.9","L03.031","M79.676","B35.1","I70.209","F02.80","F41.9","L11.0","Z20.828","U07.1","E78.00","J96.01","J12.89","I26.99","R09.02","I48.91","R40.4","R06.02","Z45.2","Z11.59","Z74.1","K59.00","K21.9","Z86.73","H25.13","R69","H43.811","Z96.1","Z86.16","B94.8","N39.0","Z03.818","Z11.52","R31.9","R53.81","F03.90"],"date":["2021-02-16","2020-08-28","2021-02-24","2020-08-28","2021-02-16","2021-02-16","2021-02-16","2020-08-28","2020-08-28","2020-08-28","2020-08-31","2021-02-05","2021-02-08","2021-02-08","2021-02-08","2020-03-05","2020-07-08","2020-07-08","2020-07-08","2020-09-04","2020-06-25","2020-07-08","2020-08-25","2020-12-01","2020-08-31","2020-09-08","2020-09-08","2021-02-16","2020-08-31","2020-08-31","2020-08-31","2020-09-01","2020-09-01","2021-02-08","2021-02-16","2021-02-16","2021-02-16","2021-02-16","2021-02-16","2020-09-08","2020-11-03","2020-11-03","2021-02-16","2021-02-16","2021-02-24","2021-02-08","2021-02-16","2021-02-24","2021-02-24","2021-02-24"],"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":""}]}]}