{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MAMIE   E SMITH","gend":1,"add":"1013 HICKORY ST                                             ","city":"RICHMOND                      ","state":"VA","zip":"23220-2413","dob":"1936-10-01","age":"","mstatus":"","insh":10050608,"cliId":"","pno":8048621764,"cno":"","email":"","ename":"","eno":"","pphy":"BONNER, LLOYD ARDEN                                         ","ppno":"","pcpadd":"505 W Leigh St","pcpcity":"Richmond                      ","pcpstate":"VA","pcpzip":232203239,"pcpcounty":"","pcpid":"P0118438","pcpname":"PRIMARY HEALTH CARE ASSOCIATES","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"1013 HICKORY ST                                             ","madd2":"                                                            ","madd3":"","mcity":"RICHMOND                      ","mstate":"VA","mzip":"23220-2413","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K62.5","Z86.79","K92.1","I10","M15.0","E78.5","E78.00","Z86.73","Z71.3","Z68.21","K21.9","K57.30","K64.8","M19.90","Z87.891","Z79.1","Z20.828","I49.9","Z00.00","M17.0","Z13.31","M17.12"],"date":["2020-08-06","2020-08-06","2020-09-02","2020-10-08","2020-08-06","2020-10-08","2020-08-06","2020-08-06","2020-08-06","2020-08-06","2020-09-02","2020-09-02","2020-09-02","2020-08-31","2020-08-31","2020-08-31","2020-08-31","2020-10-08","2020-10-08","2020-10-08","2020-10-08","2020-10-08"],"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":{"comment":"","sub":[["","29300012510","MELOXICAM","15MG","30","Select","Select",""],["","00093720298","PRAVASTATIN","40MG","30","Select","Select",""],["","59651000205","OMEPRAZOLE","20MG","30","Select","Select",""],["","68180072103","AMLODIPINE","10MG","30","Select","Select",""],["","68180037803","LOSARTAN","100MG","90","Select","Select",""],["","52268001201","SUPREP","PREP KIT","354","Select","Select",""],["","29300012510","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","00093720298","PRAVASTATIN ","TAB 40MG","30","Select","Select",""],["","59651000205","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","68180072103","AMLODIPINE ","TAB 10MG","30","Select","Select",""],["","68180037803","LOSARTAN ","TAB 100MG","90","Select","Select",""],["","52268001201","SUPREP ","SOL PREP KIT","354","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":""}]}]}