{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EUGNEYA- MAE L GUINN-BAILEY","gend":1,"add":"421 CONSTITUTION AVE ","city":"PORTSMOUTH  ","state":"VA","zip":"23704-9998","dob":"1997-11-17","age":"","mstatus":"","insh":11017602,"cliId":"6XW7DV1PG51","pno":7575357511,"cno":7579497268,"email":"","ename":"","eno":"","pphy":"BAUMGARTEN, MARGARET Y","ppno":7573976344,"pcpadd":"825 Fairfax Ave,Hofheimer Hall 1st Floor Suite 118","pcpcity":"Norfolk  ","pcpstate":"VA","pcpzip":235071914,"pcpcounty":"","pcpid":"P0060136","pcpname":"PORTSMOUTH FAMILY MEDICINE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"421 CONSTITUTION AVE ","madd2":"","madd3":"","mcity":"PORTSMOUTH  ","mstate":"VA","mzip":"23704-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R27.0","R26.2","C71.6","Z98.890","R49.0","H50.9","R47.1","R47.89","R26.81","R27.8"],"date":["2021-11-29","2021-11-29","2021-11-29","2021-11-29","2021-11-22","2021-11-18","2021-11-22","2021-11-22","2021-05-25","2021-11-18"],"priorHcc":[null,null,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":[["","378001805","METOPROL ","TAB 25MG","90","Select","Select",""],["","143993905","AMOXICILLIN ","CAP 500MG","21","Select","Select",""],["","00378001805","METOPROL","25MG","90","Select","Select",""],["","00143993905","AMOXICILLIN","500MG","21","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","",""],["No","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":""}]}]}