{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GREGORY   D PALMER","gend":0,"add":"610   OGBURN ROAD                                           ","city":"LAWRENCEVILLE                 ","state":"VA","zip":"23868-2129","dob":"1969-10-16","age":"","mstatus":"","insh":10050298,"cliId":"","pno":4343139359,"cno":"","email":"","ename":"","eno":"","pphy":"ANDERSON, MICHAEL S","ppno":"","pcpadd":"6 Doctors Dr","pcpcity":"Emporia                       ","pcpstate":"VA","pcpzip":238471240,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"610   OGBURN ROAD                                           ","madd2":"                                                            ","madd3":"","mcity":"LAWRENCEVILLE                 ","mstate":"VA","mzip":"23868-2129","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M46.1","H93.93","F17.210","F20.0","F33.9","M54.9","F32.9","R06.6","K21.9","Z71.6","R63.4","Z68.1"],"date":["2019-02-08","2019-02-08","2021-08-26","2021-11-18","2020-10-29","2021-08-26","2021-08-26","2021-08-26","2021-08-26","2021-08-26","2021-08-26","2021-11-18"],"priorHcc":["","","",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":[["","65862001230","SERTRALINE","50MG","90","Select","Select",""],["","43547034106","RISPERIDONE","1MG","90","Select","Select",""],["","59676058015","JANSSEN","COVID-19","0.5","Select","Select",""],["","70010010801","GABAPENTIN","100MG","60","Select","Select",""],["","31722071390","PANTOPRAZOLE","40MG","30","Select","Select",""],["","65862001230","SERTRALINE ","TAB 50MG","90","Select","Select",""],["","43547034106","RISPERIDONE ","TAB 1MG","90","Select","Select",""],["","31722071390","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","70010010801","GABAPENTIN ","CAP 100MG","60","Select","Select",""],["","59676058015","JANSSEN ","INJ COVID-19","0.5","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","",""],["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":""}]}]}