{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LULA MCCLINTON","gend":1,"add":"1014 33RD STREET  ","city":"NEWPORT NEWS","state":"VA","zip":"23607-3510","dob":"1961-05-10","age":"","mstatus":"","insh":11016638,"cliId":"3E54T65NR07","pno":7579443236,"cno":7579443236,"email":"","ename":"","eno":"","pphy":"BOWERS, LEO C  ","ppno":7578272127,"pcpadd":"26 WINE STREET","pcpcity":"HAMPTON  ","pcpstate":"VA","pcpzip":236693584,"pcpcounty":"","pcpid":"P9058919","pcpname":"OLD HAMPTON FAMILY MEDICAL ASSOCIATES PC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1014 33RD STREET  ","madd2":"","madd3":"","mcity":"NEWPORT NEWS","mstate":"VA","mzip":"23607-3510","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["I10","E78.5","Z13.1","R60.0","I25.118","J44.9","F17.200","K21.9","M47.26","J30.2","I25.10","R06.00","Z12.31","T81.30XA","R35.0","I11.0","I50.9","T50.1X6A","Z91.128","S81.801A","S81.809A","M16.0","I87.311","L97.919","I20.8","T81.30XD","S81.801S","E66.01","I51.9","Z98.890","L89.899","L97.211","I73.9"],"date":["2021-10-19","2021-01-27","2021-01-27","2021-08-13","2021-01-22","2021-10-19","2021-07-12","2021-10-19","2021-10-19","2021-01-22","2021-02-01","2021-02-01","2021-04-26","2021-08-13","2021-07-19","2021-07-19","2021-10-19","2021-07-19","2021-07-19","2021-08-13","2021-07-12","2021-07-12","2021-10-21","2021-10-21","2021-10-19","2021-09-20","2021-10-19","2021-10-19","2021-10-19","2021-10-19","2021-10-06","2021-10-13","2021-09-29"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","",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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","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":""}]}]}