{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DAVID HICKMAN","gend":0,"add":"PO BOX 104  ","city":"QUINBY","state":"VA","zip":"23423-0104","dob":"1960-10-13","age":"","mstatus":"","insh":11015457,"cliId":"4AV5NJ9PN74","pno":7577094585,"cno":7574422083,"email":"","ename":"","eno":"","pphy":"CHICK, JON BLAIR  ","ppno":7573363682,"pcpadd":"4049 Main St","pcpcity":"Chincoteague Island  ","pcpstate":"VA","pcpzip":233362406,"pcpcounty":"","pcpid":"P9476151","pcpname":"EASTERN SHORE RURAL HEALTH SYSTEM","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"PO BOX 104  ","madd2":"","madd3":"","mcity":"QUINBY","mstate":"VA","mzip":"23423-0104","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["M20.21","Z01.818","I73.9","I25.10","J44.9","Z88.1","Z91.041","Z86.711","Z79.01","Z79.51","Z79.82","Z79.899","Z87.891","R26.2","Z98.890","M79.671","M96.89","R26.89","Z48.89","G89.28","I10","E78.5","R91.1","L03.115","L03.119","I70.234","L03.031","Z79.2","Z86.718","Z95.820","Z82.49","T81.40XA","T81.41XA","T81.31XA","B95.61","E11.51","I71.4","N40.0","I70.212","F32.9","T81.49XA","I70.229","T81.30XA","Z91.19","G89.29","G62.9","T81.30XD","R07.9","R94.31","M79.674","R73.03","N40.1","N13.8","M25.674","M54.5","M19.071","I70.221","Z95.828","F17.210","E66.09","Z68.34","Z71.3","R91.8","B35.1","L85.1","F41.9","I65.23","Z87.898","Z68.33","M54.59"],"date":["2020-12-11","2020-11-13","2021-11-18","2021-03-15","2021-10-15","2020-11-16","2020-11-16","2020-11-16","2021-03-15","2021-10-15","2020-11-16","2021-11-18","2021-10-15","2020-09-29","2020-10-05","2020-10-05","2020-10-05","2020-10-05","2020-10-05","2020-10-05","2021-09-23","2020-10-05","2021-10-15","2020-10-13","2020-10-09","2020-10-13","2020-10-30","2020-10-13","2021-03-15","2020-11-16","2020-11-16","2020-10-13","2020-10-13","2020-10-13","2020-10-13","2020-10-13","2020-11-16","2020-12-01","2020-11-16","2020-10-13","2020-10-16","2020-10-13","2020-10-23","2020-10-23","2021-11-18","2021-11-18","2020-10-30","2021-04-21","2020-12-03","2020-12-03","2021-09-23","2021-11-08","2021-11-08","2020-12-11","2021-09-21","2021-02-25","2020-11-16","2020-11-16","2021-03-09","2021-09-23","2021-03-09","2021-09-23","2021-04-09","2021-05-28","2021-05-28","2021-09-23","2021-08-24","2021-08-27","2021-09-23","2021-11-18"],"priorHcc":["","",null,"","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,null,"","","","","",null,null,"","","","","","","","","","","","","","","","",null]}},{"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","",""],["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":""}]}]}