{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EALUM   R HOLLEY","gend":0,"add":"MICHAEL AND LIBBY HOLLEY                                    ","city":"HAMPTON                       ","state":"VA","zip":"23666-2266","dob":"2002-01-29","age":"","mstatus":"","insh":10082241,"cliId":"","pno":7578263644,"cno":7578263644,"email":"","ename":"","eno":"","pphy":"SHEPPARD, THERESA M","ppno":"","pcpadd":"23 Manhattan Sq,Ste 300","pcpcity":"Hampton                       ","pcpstate":"VA","pcpzip":236665843,"pcpcounty":"","pcpid":"P9307362","pcpname":"HAMPTON ROADS PEDIATRICS","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"TIDEWATER","aligned":"","ano":"","add2":"6 STEEPLECHASE LOOP                                         ","add3":"","madd1":"MICHAEL AND LIBBY HOLLEY                                    ","madd2":"6 STEEPLECHASE LOOP                                         ","madd3":"","mcity":"HAMPTON                       ","mstate":"VA","mzip":"23666-2266","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H93.293","R48.0","Z00.129","Z68.52","Z13.31","Z13.39","F84.0","Z71.3","H50.05","Z71.82","Z23","S40.021A","W50.0XXA","Y92.219","Z00.00","H93.299","Z13.220"],"date":["2019-09-04","2020-02-05","2019-11-14","2019-11-14","2020-11-18","2020-11-18","2020-11-18","2020-11-18","2019-11-14","2020-11-18","2020-11-18","2020-01-29","2020-01-29","2020-01-29","2020-11-18","2020-11-18","2020-11-18"],"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","",""],["N\/A","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":""}]}]}