{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DEBRA BARGO","gend":1,"add":"7101 NEW HUNTER  ROAD","city":"MECHANICSVILLE ","state":"VA","zip":"23111-1949","dob":"1956-10-04","pno":8045258365,"cno":8045258365,"email":"","pphy":"BIGGERS, JONATHAN WOODRUFF ","ppno":8047469055,"pcpadd":"11814 King William Rd","pcpcity":"Aylett","pcpstate":"VA","pcpzip":230094103,"pcpcounty":"","pcpid":"P0060286","pcpname":"KING WILLIAM DAWN COMMUNITY DOCTORS","insh":11018595,"cliId":"8Y18AP8AQ52","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"APARTMENT 1111 ","add3":"","madd1":"7101 NEW HUNTER  ROAD","madd2":"APARTMENT 1111 ","madd3":"","mcity":"MECHANICSVILLE ","mstate":"VA","mzip":"23111-1949","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.30","E78.5","J44.9","F33.9","K21.9","E55.9","R41.3","I10","G47.33","E78.2","Z23","Z12.31"],"date":["2021-11-15","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2021-11-15"],"priorHcc":[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":[["","31722071390","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","43547040011","CYCLOBENZAPR ","TAB 10MG","90","Select","Select",""],["","13668010390","DONEPEZIL ","TAB 10MG","90","Select","Select",""],["","43547035411","LISINOPRIL ","TAB 20MG","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":""}]}]}