{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KRISTY F KIDD","gend":1,"add":"12109 Fort Craig Dr  ","city":"Woodbridge  ","state":"VA","zip":"22192-1007","dob":"1985-11-04","age":"","mstatus":"","insh":11018522,"cliId":"9TP4YV3XK80","pno":3216987609,"cno":"","email":"","ename":"","eno":"","pphy":"GHADGE, PRIYA  ","ppno":8045273588,"pcpadd":"1043 Sterling Rd Ste 104","pcpcity":"Herndon  ","pcpstate":"VA","pcpzip":201703842,"pcpcounty":"","pcpid":"P0060397","pcpname":"MILLENIUM MEDICAL CORPORATION","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"N","ano":"","add2":"","add3":"","madd1":"12109 Fort Craig Dr  ","madd2":"","madd3":"","mcity":"Woodbridge  ","mstate":"VA","mzip":"22192-1007","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z00.00","Z23","F84.0","Z11.1","Z01.00","Z01.419","R79.89","D75.89","E66.01","Z68.42"],"date":["2021-10-27","2021-10-13","2021-10-13","2021-10-13","2021-10-13","2021-10-13","2021-10-27","2021-10-27","2021-10-27","2021-10-13"],"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":[["","43547034150","RISPERIDONE","1MG","60","Select","Select",""],["","60505265401","TRAZODONE","100MG","30","Select","Select",""],["","60505265401","TRAZODONE ","TAB 100MG","30","Select","Select",""],["","43547034150","RISPERIDONE ","TAB 1MG","60","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":""}]}]}