{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BARBARA DUNBAR","gend":1,"add":"14606 ASHDALE AVENUE ","city":"WOODBRIDGE  ","state":"VA","zip":"22193-1242","dob":"1962-12-30","age":"","mstatus":"","insh":11018639,"cliId":"8EK4Q63XY66","pno":5712216953,"cno":5712216953,"email":"","ename":"","eno":"","pphy":"HEGDE, DINRAJ  ","ppno":7035905999,"pcpadd":"2601 Hospital Blvd Ste 112 and 117","pcpcity":"Corpus Christi ","pcpstate":"TX","pcpzip":784051865,"pcpcounty":"","pcpid":"P0060397","pcpname":"MILLENIUM MEDICAL CORPORATION","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"14606 ASHDALE AVENUE ","madd2":"","madd3":"","mcity":"WOODBRIDGE  ","mstate":"VA","mzip":"22193-1242","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Q61.2","I10","E78.5","E11.69","E78.2","F17.200","E55.9","E11.641","Z01.812","Z20.822","R91.8","M85.80","Z23","M20.42","E10.51","M20.12","M65.872","S93.332A","B07.0","B07.8"],"date":["2021-10-12","2021-10-12","2021-10-12","2021-10-12","2021-10-12","2021-10-12","2021-10-12","2021-10-12","2021-10-11","2021-10-11","2021-10-12","2021-10-12","2021-11-10","2021-10-06","2021-10-06","2021-10-06","2021-10-06","2021-10-06","2021-10-18","2021-10-18"],"priorHcc":["","","","","","","","","","","","",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":[]},{"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":"","a12":""}]}]}