{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARK O AVERY","gend":0,"add":"451 LARCHMONT CIRCLE","city":"RUCKERSVILLE","state":"VA","zip":229683237,"dob":"1954-06-14","age":"","mstatus":"","insh":11017379,"cliId":"6XT0RV3QH10","pno":4345314279,"cno":"","email":"","ename":"","eno":"","pphy":"BOSTIC, BROOKE A","ppno":4349852891,"pcpadd":"140 Stoneridge Dr S","pcpcity":"Ruckersville","pcpstate":"VA","pcpzip":229683096,"pcpcounty":"","pcpid":"P9307359","pcpname":"GREENE FAMILY MEDICINE","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":"Previously Documented Conditions","q":[{"a":{"diag":["I10","W19.XXXA","Z91.81","Z11.1","Z76.89","Z86.69","Z98.2","Z85.46","G31.84","R29.6","G91.9","F03.90","R74.8","R94.5","G91.2","R51.9","L60.0","K76.0","I70.91","B35.1","H90.A22"],"date":["2021-06-11","2021-03-23","2021-03-23","2021-03-23","2021-03-23","2021-03-23","2021-03-23","2021-03-23","2021-04-21","2021-03-26","2021-06-11","2021-06-11","2021-04-27","2021-04-07","2021-04-13","2021-04-13","2021-06-11","2021-04-27","2021-06-23","2021-06-23","2021-06-04"],"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":[["","68001033408","LISINOPRIL","TAB 10MG","","Select","Select",""],["","68001033408","LISINOPRIL ","TAB 10MG","30","Select","Select",""],["","69315011610","FUROSEMIDE ","20MG","5","Select","Select",""],["","43386091710","POT  CHLORIDE","20MEQ ER","5","Select","Select",""]]}},{"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":[[["Select","Select","",false,""],["Select","Select","",false,""],["Select","Select","",false,""],["Select","Select","",false,""],["Select","Select","",false,""],["Select","Select","",false,""],["No","Select","",false,""]]]},{"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":""}]}]}