{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAINA   A ROSARIO COSME","gend":1,"add":"899   PORT REPUBLIC ROAD                                    ","city":"HARRISONBURG                  ","state":"VA","zip":"22801-3355","dob":"2002-07-14","age":"","mstatus":"","insh":10122399,"cliId":"","pno":5406078236,"cno":5406078236,"email":"","ename":"","eno":"","pphy":"HOTCHKISS, JEROME J                                         ","ppno":"","pcpadd":"1661 S Main St","pcpcity":"Harrisonburg                  ","pcpstate":"VA","pcpzip":228012728,"pcpcounty":"","pcpid":"P0124711","pcpname":"HARRISONBURG COMMUNITY HEALTH CENTER INC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"APT 107L                                                    ","add3":"","madd1":"899   PORT REPUBLIC ROAD                                    ","madd2":"APT 107L                                                    ","madd3":"","mcity":"HARRISONBURG                  ","mstate":"VA","mzip":"22801-3355","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R55","S09.90XA","R42","R11.0","W18.2XXA","Y93.E1","Y92.002","Z88.2","Z23","Z00.129","J45.20","Z71.89","Z71.3","L70.0","Z00.00","Z30.09"],"date":["2019-11-15","2019-11-14","2019-11-14","2019-11-14","2019-11-14","2019-11-14","2019-11-14","2019-11-14","2021-03-04","2019-11-15","2019-11-15","2019-11-15","2019-11-15","2019-11-15","2021-03-04","2021-03-04"],"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":[["","68180089173","ENSKYCE","","28","Select","Select",""],["","68180089173","ENSKYCE ","TAB ","28","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","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}