{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DAVID W COLVIN","gend":0,"add":"1800 TOWLER RD ","city":"DRAKES BRANCH  ","state":"VA","zip":"23937-2753","dob":"1971-09-14","age":"","mstatus":"","insh":11017972,"cliId":"6G35Y47CN52","pno":4342106055,"cno":4345687765,"email":"","ename":"","eno":"","pphy":"ALGEIER, RHONDA M","ppno":4345425522,"pcpadd":"165 LEGRANDE AVE","pcpcity":"CHARLOTTE COURT HOUSE","pcpstate":"VA","pcpzip":239233747,"pcpcounty":"CHARLOTTE","pcpid":"P9476190","pcpname":"RHONDA BARKSDALE ALGEIER MD AND ASSOCIATES","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1800 TOWLER RD ","madd2":"","madd3":"","mcity":"DRAKES BRANCH  ","mstate":"VA","mzip":"23937-2753","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.9","E11.9","E11.65","E87.1","E87.2","M43.17","I10","E78.5","I25.10","F33.1","K21.9","E66.01","Z68.41","G89.29","Z72.0","Z79.4","Z79.82","Z79.899","M54.5","F17.210","I70.0","M47.816","M47.817","M48.07","R73.9","M54.9","S59.902A","M79.89","F31.9","S51.002D","F31.81","F10.10","M62.81","R26.2","S50.02XA","M25.522","S50.312A","F10.239","F31.4","F32.9","R45.851","K76.0","Z68.38","F10.20","F14.10","F15.10","F43.10","Z23","Z01.811","F19.10","Z20.822","T50.995A","F41.9","Q80.9","Z68.37","Z95.5"],"date":["2021-10-06","2021-11-01","2021-06-03","2021-06-30","2021-06-03","2021-06-03","2021-11-05","2021-11-05","2021-11-05","2021-06-03","2021-11-05","2021-11-05","2021-06-03","2021-06-30","2021-06-03","2021-11-05","2021-11-05","2021-10-06","2021-07-19","2021-11-05","2021-06-03","2021-06-03","2021-06-03","2021-06-03","2021-06-03","2021-06-03","2021-06-20","2021-06-20","2021-11-24","2021-06-30","2021-06-30","2021-06-30","2021-07-19","2021-07-19","2021-06-20","2021-06-20","2021-06-20","2021-10-15","2021-11-05","2021-10-15","2021-10-15","2021-11-05","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2021-10-19","2021-10-15","2021-10-15","2021-10-06","2021-11-05","2021-11-05","2021-11-05","2021-11-05"],"priorHcc":[null,null,"","","","",null,null,null,"",null,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":{"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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","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":""}]}]}