{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NATHANIEL B WHITE","gend":0,"add":"1540 FOUNDERS PL","city":"CHARLOTTESVILLE               ","state":"VA","zip":"22902-9998","dob":"1943-04-11","age":"","mstatus":"","insh":11017851,"cliId":"5AW2FX7NJ23","pno":2023690611,"cno":5407485803,"email":"","ename":"","eno":"","pphy":"COOLEY, AMY A","ppno":5409486871,"pcpadd":"13198 James Madison Hwy,","pcpcity":"Orange","pcpstate":"VA","pcpzip":229602808,"pcpcounty":"","pcpid":"P9307431","pcpname":"ORANGE FAMILY PHYSICIANS","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"N","ano":"","add2":"","add3":"","madd1":"7001 ONYX CT","madd2":"","madd3":"","mcity":"CAPITOL HEIGHTS","mstate":"MD","mzip":"20743-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F10.10","E43","M62.81","R13.12","G93.49","T68.XXXD","I69.898","R26.2","D61.818","Z23","M62.82","F10.139","Z00.01","I67.9","H25.813","H04.123","H02.883","H52.03","H02.886","H52.203","H52.4","K21.9","E44.0","D81.818"],"date":["2021-10-21","2021-09-01","2021-10-21","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-06-17","2021-06-17","2021-04-21","2021-04-21","2021-04-21","2021-04-21","2021-04-21","2021-04-21","2021-04-21","2021-10-21","2021-10-21","2021-10-21"],"priorHcc":[null,null,null,null,null,null,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":[]},{"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":[]},{"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":""}]}]}