{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GEORGE MORTON JR","gend":0,"add":"92 HIGH MOUNTAIN ACRES LANE","city":"PALMYRA  ","state":"VA","zip":"22963-5380","dob":"1975-09-21","age":"","mstatus":"","insh":11014186,"cliId":"9YR3HV5FT06","pno":4342705045,"cno":4342705045,"email":"","ename":"","eno":"","pphy":"CASTRODALE, BRETT L  ","ppno":4342439466,"pcpadd":"112 Crofton Place","pcpcity":"Palmyra  ","pcpstate":"VA","pcpzip":229633363,"pcpcounty":"","pcpid":"P0110912","pcpname":"UVA PRIMARY AND SPECIALITY CARE ZIONS CROSS","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"92 HIGH MOUNTAIN ACRES LANE","madd2":"","madd3":"","mcity":"PALMYRA  ","mstate":"VA","mzip":"22963-5380","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["I50.22","J01.90","B96.89","I42.8","Z95.810","E78.5","N52.2","Z23","R39.12","N52.1","G47.30","J30.9","M10.9","E55.9","I11.0","I50.9","E78.00","K59.00","E66.1","Z68.36","R52","K21.9","G47.33","K04.7","Z00.00","E11.9","I10","N18.31","Z12.5"],"date":["2021-10-15","2020-10-19","2020-10-19","2021-08-26","2021-08-26","2021-10-15","2021-10-15","2021-10-15","2020-10-17","2020-10-17","2020-10-17","2020-10-17","2020-10-17","2020-10-17","2020-10-17","2020-10-17","2020-10-17","2020-10-17","2020-10-17","2020-10-17","2020-10-17","2020-10-17","2020-10-17","2021-10-06","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2021-10-15"],"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","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","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":""}]}]}