{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" JUAKITA R BOWENS","gend":1,"add":"4212 OLD BROOK ROAD","city":"RICHMOND","state":"VA","zip":"23227-9998","dob":"1962-03-29","age":"","mstatus":"","insh":10069637,"cliId":"","pno":"8046873359, 8046873359","cno":"","email":"","ename":"","eno":"","pphy":"UNKNOWN PROVIDER QNXT PCP","ppno":"               ","pcpadd":"UNKNOWN STREET, ","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":232190000,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"APT 1","add3":"","madd1":"4212 OLD BROOK ROAD","madd2":"APT 1","madd3":"","mcity":"RICHMOND","mstate":"VA","mzip":"23227-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F25.0","M16.0","M16.9","Z92.29","R79.89","R79.9","E53.8","R53.1","R63.4","E55.9","R68.89","Z12.31","R92.8","F11.23","F11.21","M25.551","G89.29","E11.9","F17.210","I10","I25.10","J45.909","M16.10","Z79.899","M16.11","M25.559","F25.1","E11.65","Z68.31","Z96.1","J98.09","R91.8","M41.9","Z68.34","M54.9","H33.002","H26.492","F11.20","M79.641","M79.89","R52","M19.041","Z71.6","Z79.1","Z82.49","Z68.32","R10.30","M79.606","Z68.33","R60.0","M25.512","I51.7","L03.311","L02.211","E88.1","R00.0","F25.9","F14.10","F11.11","E78.5","E66.9","Z91.14","Z79.4","Z79.51","F31.9","F17.209","Z68.30","S76.911A","M79.604","X58.XXXA","Z00.00","I11.9","R05","R10.32","M79.602","M85.80","K59.00","M19.031","F20.9","F17.200","N64.89","I49.9","I21.19","Z12.4","M21.70","M17.0","M25.751","M47.816","M79.651","M79.609","D70.2","E07.9","R07.9","R06.02","R30.0","L03.314","M85.841","H33.001","A41.9","R19.04","J30.9","Z23","E11.3212","N34.1","A56.2","A59.01","F32.9","Z68.29","R89.9","R94.31","S89.91XA","S79.911A","E11.3293","T78.40XA","J44.9","R13.10","F11.10","M15.9"],"date":["2021-04-16","2021-05-03","2019-08-08","2021-04-05","2021-04-05","2021-04-05","2021-04-05","2020-05-01","2020-05-01","2021-04-05","2021-04-05","2019-05-31","2019-06-13","2020-11-18","2020-12-16","2021-05-17","2021-05-08","2021-05-08","2021-05-08","2021-05-08","2021-03-15","2021-03-15","2019-08-03","2021-03-15","2021-03-15","2021-05-03","2020-07-26","2020-10-01","2020-12-01","2020-11-19","2020-03-30","2020-03-30","2020-03-30","2020-08-03","2020-07-23","2020-11-19","2020-11-19","2021-05-19","2021-03-15","2021-03-15","2021-03-15","2021-03-15","2021-03-15","2021-03-15","2021-03-15","2020-02-24","2020-03-11","2020-03-24","2020-06-23","2020-03-24","2020-04-04","2020-06-11","2020-06-12","2020-06-23","2020-06-11","2020-06-11","2020-06-11","2020-06-11","2020-06-11","2020-06-11","2021-05-03","2020-06-11","2021-05-08","2020-06-11","2021-01-28","2020-06-12","2021-02-24","2019-02-01","2019-02-01","2019-02-01","2019-04-16","2021-04-05","2020-12-01","2020-03-11","2020-04-17","2020-04-17","2020-06-11","2021-01-28","2021-01-28","2021-05-03","2019-06-13","2020-06-11","2020-06-11","2020-12-01","2021-05-03","2021-05-03","2021-05-03","2021-05-03","2019-02-01","2020-10-01","2019-10-09","2019-10-09","2020-03-30","2021-04-05","2020-08-03","2020-09-01","2020-02-13","2020-02-25","2020-06-11","2020-06-11","2020-10-01","2020-10-07","2020-11-19","2020-12-01","2020-12-01","2020-12-01","2021-01-26","2021-04-05","2021-04-05","2021-04-05","2019-02-06","2019-02-06","2019-05-14","2020-02-25","2020-02-25","2020-06-23","2020-06-11","2021-01-28"],"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":[["","00536252525","CAPSAICIN ","CRE 0.00025","60","Select","Select",""],["","64380073706","VITAMIN ","CAP 50000UNT","4","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}