{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WILHELMENA F SCOTT","gend":1,"add":"222 N DIVISION ST","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1952-07-01","age":"","mstatus":"","insh":11018259,"cliId":"8M63FD6XN95","pno":7573627527,"cno":7573627527,"email":"","ename":"","eno":"","pphy":"BROWN-TRUDEL, LINDA","ppno":7579251866,"pcpadd":"157 N MAIN ST, STE A","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":234344565,"pcpcounty":"","pcpid":"P0153071","pcpname":"SOUTHEASTERN VIRGINIA HEALTH SYSTEM AT WESTERN TID","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"N","ano":"","add2":"","add3":"","madd1":"222 N DIVISION ST","madd2":"","madd3":"","mcity":"SUFFOLK","mstate":"VA","mzip":"23434-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G40.109","Z68.41","I10","F03.90","G40.909"],"date":["2021-06-07","2021-06-07","2021-06-15","2021-06-15","2021-06-15"],"priorHcc":["","","","",""]}},{"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":[["","31722053960","LEVETIRACETA ","1000MG","60","Select","Select",""],["","68180098001","LISINOPRIL ","10MG","90","Select","Select",""],["","68180051801","LISINOP\/HCTZ ","10-12.5","90","Select","Select",""],["","31722055190","LEVOCETIRIZI ","5MG","90","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":"","a12":""}]}]}