{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CORTEZ   D BRIGGS","gend":0,"add":"1114  E BOOKER CIRCLE                                       ","city":"PETERSBURG                    ","state":"VA","zip":"23803-5510","dob":"1992-07-18","age":"","mstatus":"","insh":10028519,"cliId":"","pno":8043240751,"cno":8043240751,"email":"","ename":"","eno":"","pphy":"PASCO, HAYDEN                                               ","ppno":"","pcpadd":"12018 W Broad St Ste 100","pcpcity":"Richmond                      ","pcpstate":"VA","pcpzip":232337796,"pcpcounty":"","pcpid":"P0124051","pcpname":"PRIMARY HEALTH GROUP INC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"1114  E BOOKER CIRCLE                                       ","madd2":"                                                            ","madd3":"","mcity":"PETERSBURG                    ","mstate":"VA","mzip":"23803-5510","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L08.9","B20","H02.013","R76.0","L03.116","M79.672","F17.210","A53.9","H91.90","Z23","H20.9","H52.03","Z21","Z79.899","H52.201","B18.2"],"date":["2019-05-26","2021-11-09","2019-05-28","2019-06-06","2019-09-09","2019-09-09","2019-09-09","2021-06-09","2019-11-13","2021-11-09","2020-06-02","2020-06-02","2020-06-02","2021-11-09","2021-06-09","2021-06-22"],"priorHcc":["",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":[["","61958190101","GENVOYA","","30","Select","Select",""],["","61958190101","GENVOYA ","TAB ","30","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","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}