{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOHNNY A MCCONNELL","gend":0,"add":"5205 BRISTOL HIGHWAY ","city":"GATE CITY","state":"VA","zip":"24251-9998","dob":"1963-06-30","age":"","mstatus":"","insh":11017992,"cliId":"5E78YT5NQ47","pno":2765946259,"cno":2765946254,"email":"","ename":"","eno":"","pphy":"CARROLL, DANIEL D ","ppno":2764694200,"pcpadd":"24530 Falcon Place Blvd,Ste 102","pcpcity":"Abingdon ","pcpstate":"VA","pcpzip":242117665,"pcpcounty":"","pcpid":"P9059229","pcpname":"WELLMONT MEDICAL ASSOCIATES INC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"5205 BRISTOL HIGHWAY ","madd2":"","madd3":"","mcity":"GATE CITY","mstate":"VA","mzip":"24251-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.818","E11.65","B07.8","L23.7","Z79.899","I10","E11.9","M19.90","E03.9","E78.1","E11.40","M17.11","Z83.3","Z79.52","B35.1","M79.674","M79.675","L60.3","E11.41","H40.013","M51.26","M19.011","R21","E11.42","M54.5","L84","E11.59","K76.0","E88.81","Z68.37","I15.2","Z23","M25.775","M20.42","M20.22","G89.29","M46.02","M46.1","L97.529"],"date":["2021-07-15","2021-09-30","2021-05-13","2021-06-28","2021-09-14","2021-09-30","2021-09-30","2021-05-27","2021-09-30","2021-09-30","2021-09-30","2021-06-17","2021-07-15","2021-07-15","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2021-07-08","2021-11-09","2021-11-09","2021-06-28","2021-10-12","2021-09-14","2021-11-15","2021-09-30","2021-09-30","2021-09-30","2021-09-30","2021-09-30","2021-09-30","2021-11-15","2021-11-15","2021-11-15","2021-10-12","2021-10-12","2021-11-09","2021-11-15"],"priorHcc":["","","","","","","","","","","","","","",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":""}]}]}