{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CALVIN C POWELL","gend":0,"add":"106 SPRINGFOREST DRIVE","city":"RICHMOND                      ","state":"VA","zip":"23223-3396","dob":"1956-05-26","age":"","mstatus":"","insh":11017552,"cliId":"9QX6J42FK55","pno":8046132252,"cno":8047648954,"email":"","ename":"","eno":"","pphy":"AYALA-SIMS, VERONICA A","ppno":8047800840,"pcpadd":"1300 E MARSHALL STREET,","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":232985054,"pcpcounty":"","pcpid":"P9058672","pcpname":"GLENWOOD MEDICAL CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"APARTMENT F","add3":"","madd1":"106 SPRINGFOREST DRIVE","madd2":"APARTMENT F","madd3":"","mcity":"RICHMOND","mstate":"VA","mzip":"23223-3396","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R51.9","I10","H00.016","H10.32","H00.015","R41.89","R01.1","E78.5","Z79.899","M79.89","R41.3","I49.1","I44.7","R22.43","M19.071","M19.072","R00.1","R94.31","G93.9","R90.82","M25.572","R22.42","Z23","M25.579","Z12.11"],"date":["2021-09-20","2021-10-11","2021-05-22","2021-05-22","2021-05-22","2021-08-12","2021-08-12","2021-08-12","2021-08-12","2021-10-11","2021-09-20","2021-08-27","2021-08-27","2021-08-27","2021-08-27","2021-08-27","2021-08-27","2021-08-27","2021-09-20","2021-09-20","2021-10-11","2021-10-11","2021-10-11","2021-10-11","2021-10-12"],"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":[]},{"a":[]}]},{"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":[["","17478030703","AZASITE ","1%","2.5","Select","Select",""],["","17478030703","AZASITE","0.01","2.5","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":[[["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":""}]}]}