{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"IZIAH BRISCO","gend":0,"add":"27258 LANKFORDHIGHWAY ","city":"MELFA ","state":"VA","zip":"23410-2899","dob":"1974-07-16","age":"","mstatus":"","insh":10047081,"cliId":"","pno":7573500875,"cno":7573500875,"email":"","ename":"","eno":"","pphy":"DALESSIO, DAVID F ","ppno":"","pcpadd":"216 Mason Ave, ","pcpcity":"Cape Charles","pcpstate":"VA","pcpzip":233103200,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"TIDEWATER","aligned":"","ano":"","add2":"APT 4 ","add3":"","madd1":"27258 LANKFORDHIGHWAY ","madd2":"APT 4 ","madd3":"","mcity":"MELFA ","mstate":"VA","mzip":"23410-2899","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C62.12","R74.0","M54.5","G80.1","E78.49","R26.81","G25.2","I10","E55.9","R25.1","Z03.818","R03.0","R74.02","Z08","Z85.47","Z90.79","Z92.21","R26.9","G80.9","R47.1","Z23","M54.41","E11.65","R19.7","R11.2","E78.5","Z79.899","E11.9","R35.0","R68.2","Z79.84","E78.2","M51.26","M48.061","M51.36","M54.50"],"date":["2021-09-30","2020-09-25","2021-06-10","2019-11-11","2019-10-30","2019-10-30","2021-05-06","2021-10-11","2021-10-11","2019-11-11","2020-07-01","2020-07-22","2021-09-30","2021-03-31","2021-04-08","2020-10-01","2020-10-01","2021-05-06","2021-10-07","2021-05-06","2021-06-17","2021-06-22","2021-10-11","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2021-10-07","2021-10-11","2021-10-15","2021-10-15","2021-10-15","2021-10-15"],"priorHcc":["","","","","","","",null,null,"","","","","","","","","",null,"","","",null,null,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":[["","68180047903","SIMVASTATIN","20MG","30","Select","Select",""],["","68180072003","AMLODIPINE","5MG","30","Select","Select",""],["","68180051902","LISINOP\/HCTZ","20-12.5","30","Select","Select",""],["","80681000900","VITAMIN","50MCG","90","Select","Select",""],["","31604002678","D3","2000UNIT","90","Select","Select",""],["","11917017072","MULTIVITAMIN","ADULTS","30","Select","Select",""],["","43547040650","CLONAZEPAM","0.5MG","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","",""],["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":""}]}]}