{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LASABRA   L SHOULDERS","gend":1,"add":"2648 CHESAPEAKE BOULEVARD                                   ","city":"NORFOLK                       ","state":"VA","zip":"23509-1762","dob":"1994-11-21","age":"","mstatus":"","insh":10091585,"cliId":"","pno":7578319106,"cno":7573052853,"email":"","ename":"","eno":"","pphy":"MACK, ALEXANDRA SLEDD                                       ","ppno":"","pcpadd":"825 Fairfax Ave,Ste H","pcpcity":"NORFOLK                       ","pcpstate":"VA","pcpzip":235071914,"pcpcounty":"","pcpid":"P0060129","pcpname":"GHENT FAMILY PRACTICE","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"TIDEWATER","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"2648 CHESAPEAKE BOULEVARD                                   ","madd2":"                                                            ","madd3":"","mcity":"NORFOLK                       ","mstate":"VA","mzip":"23509-1762","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.5","M54.6","V49.40XA","Y92.410","F17.210","M54.2","R10.13","R10.9","R11.2","F17.200","F12.10","R10.2","N89.8","Z11.3","J45.901","R09.81","R06.02","R05","J45.41","R06.2","R07.89","E87.6","J45.909","R11.15","R10.84","R19.7","N83.01","M62.830","E66.9","Z68.24","N83.291","R10.11"],"date":["2021-02-23","2021-02-23","2019-12-18","2019-12-18","2021-10-05","2020-03-02","2021-10-05","2020-01-31","2021-10-05","2020-11-27","2020-11-27","2021-06-09","2020-06-25","2020-06-25","2020-11-12","2020-11-12","2020-11-13","2020-11-12","2020-11-13","2020-11-13","2020-11-13","2020-11-13","2020-11-13","2020-11-27","2020-11-27","2021-06-30","2021-02-17","2021-02-23","2021-02-23","2021-02-23","2021-06-09","2021-06-30"],"priorHcc":["","","","",null,"",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":[]},{"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":""}]}]}