{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LESTER MATHIS JR","gend":0,"add":"420 BRIAN AVENUE                                            ","city":"VIRGINIA BEACH                ","state":"VA","zip":"23462-2002","dob":"1957-05-09","age":"","mstatus":"","insh":10047532,"cliId":"","pno":5705165528,"cno":5705165528,"email":"","ename":"","eno":"","pphy":"HOLMES, BERT W                                              ","ppno":"","pcpadd":"301 Riverview Ave Ste 502","pcpcity":"Norfolk                       ","pcpstate":"VA","pcpzip":235101065,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"TIDEWATER","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"420 BRIAN AVENUE                                            ","madd2":"                                                            ","madd3":"","mcity":"VIRGINIA BEACH                ","mstate":"VA","mzip":"23462-2002","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I63.031","F01.50","R68.89","F19.10","R53.1","R05","R47.81","W22.8XXA","F10.129","R07.89","J44.9","R10.9","M25.552","I25.10","M50.30","F14.929","F12.90","S29.9XXA","R41.0","S19.9XXA","S39.91XA","R07.9"],"date":["2019-01-17","2019-01-17","2019-01-28","2020-04-02","2020-04-02","2020-04-02","2020-04-02","2020-04-02","2020-04-02","2020-04-02","2020-04-02","2020-04-02","2020-04-02","2020-04-02","2020-04-02","2020-04-02","2020-04-02","2020-04-02","2020-04-02","2020-04-02","2020-04-02","2020-04-02"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}