{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DUSTIN   L TURMAN","gend":0,"add":"7172 COVE HOLLOW RD                                         ","city":"ELLISTON                      ","state":"VA","zip":"24087-2604","dob":"1995-12-01","age":"","mstatus":"","insh":10038563,"cliId":"","pno":5403803235,"cno":5403803235,"email":"","ename":"","eno":"","pphy":"HEMPHILL, JULIA T                                           ","ppno":"","pcpadd":"6920 ROANOKE ROAD,Ste B3","pcpcity":"SHAWSVILLE                    ","pcpstate":"VA","pcpzip":241620001,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"7172 COVE HOLLOW RD                                         ","madd2":"                                                            ","madd3":"","mcity":"ELLISTON                      ","mstate":"VA","mzip":"24087-2604","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L03.90","L02.91","E66.9","Q90.9","M21.062","M25.562","S83.002A","X50.1XXA","S83.012A","S83.012D","X58.XXXD","S83.512D","S83.412D","S83.102A","S83.005D","M25.561","S83.282A","M25.462","M25.469","S83.412A","M79.89","M79.662","R60.0","M79.605","R26.2","M62.81","M25.662","Z98.890","N50.89","K40.90","N50.82","Z68.39","L73.9","R21","Z68.41","N50.819","E78.5","F79","H60.92"],"date":["2019-03-14","2019-03-14","2021-08-03","2021-07-30","2019-04-03","2019-10-01","2019-06-03","2019-05-31","2019-05-31","2019-06-09","2019-10-01","2019-06-09","2019-06-09","2019-06-09","2019-10-01","2019-06-19","2019-07-03","2019-06-19","2019-06-19","2019-07-03","2019-08-13","2019-08-13","2019-09-06","2019-09-06","2019-10-01","2019-10-01","2019-10-01","2019-10-22","2020-01-09","2020-01-09","2019-11-20","2019-11-25","2019-12-08","2019-12-08","2019-12-13","2020-01-09","2021-11-02","2021-07-30","2021-08-03"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","61314064511","NEO\/POLY\/HC","1% OTIC","10","Select","Select",""],["","61314064511","NEO\/POLY\/HC ","SUS 1% OTIC","10","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":""}]}]}