{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" JAMES  CLEMONS","gend":0,"add":"6508 JOHNSON MTN ROAD","city":"HUDDLESTON","state":"VA","zip":"24104-8506","dob":"1954-06-12","age":"","mstatus":"","insh":10054069,"cliId":"","pno":"5408758237, 5408758237","cno":"","email":"","ename":"","eno":"","pphy":"ROBERTSON, SANDRA JO","ppno":"               ","pcpadd":"428 S Magnolia Ave, Ste 1","pcpcity":"Waynesboro","pcpstate":"VA","pcpzip":229803629,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"6508 JOHNSON MTN ROAD","madd2":"                                                            ","madd3":"","mcity":"HUDDLESTON","mstate":"VA","mzip":"24104-8506","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F17.210","K20.8","M19.90","Z72.0","Z23","M47.815","G47.00","K57.30","K44.9","R10.9","R10.13","Z86.19","R93.89","K31.89","R06.00","I10","Z12.2","M62.08","K29.70","R91.8","R91.1","J84.10","I25.10","J44.9","J30.9","K20.90","G43.109","J02.0","R50.9","M54.12","R59.0","K21.0","B37.81","Z87.19","K46.9","Z72.89","I83.90","M51.9","R93.3","K29.50","K20.9","Z88.1","Z79.82","Z79.899","Z80.0"],"date":["2019-10-02","2019-10-02","2020-03-04","2020-10-05","2020-03-04","2020-03-04","2020-03-04","2019-08-28","2019-10-02","2019-08-28","2019-10-02","2019-10-02","2020-01-29","2019-10-15","2020-01-24","2020-10-05","2019-01-25","2019-08-28","2019-10-02","2020-01-29","2020-10-02","2020-10-02","2020-01-29","2019-05-13","2020-04-03","2020-10-05","2020-10-05","2019-01-06","2019-01-06","2019-07-09","2019-08-28","2019-08-28","2019-10-02","2019-10-02","2019-07-09","2019-07-09","2019-07-09","2019-07-09","2019-10-02","2019-10-02","2019-10-02","2019-10-02","2019-10-02","2019-10-02","2019-10-02"],"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":{"comment":"","sub":[["","13107005501","OXYCODONE ","TAB 5MG","120","Select","Select",""],["","68645055254","LISINOPRIL ","TAB 10MG","30","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":""}]}]}