{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EUGENE MICOMYIZA","gend":0,"add":"1382 BRADLEY DRIVE","city":"HARRISONBURG","state":"VA","zip":"22801-5200","dob":"1964-12-12","age":"","mstatus":"","insh":10142940,"cliId":"","pno":5402094116,"cno":5402094116,"email":"","ename":"","eno":"","pphy":"KOCH, ADRIENNE J","ppno":5405647100,"pcpadd":"1871 Evelyn Byrd Ave, ","pcpcity":"Harrisonburg","pcpstate":"VA","pcpzip":228013487,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"1382 BRADLEY DRIVE","madd2":"                                                            ","madd3":"","mcity":"HARRISONBURG","mstate":"VA","mzip":"22801-5200","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R76.12","R76.11","J84.9","R93.89","R03.0","M75.81","R51","K08.89","W01.0XXA","J32.0","I10","Z79.1","J98.4","S09.90XA","S09.93XA","M25.572","M25.512","G89.29","J94.8","A74.9","M54.5","M99.03","R91.8","M19.012","M77.32","S82.92XA","S82.91XA","R91.1","S60.111A","S42.002S","S82.202S"],"date":["2019-04-04","2019-04-18","2019-10-17","2019-11-14","2019-05-06","2019-05-06","2019-05-11","2019-05-11","2019-05-11","2019-05-11","2019-05-11","2019-05-11","2019-04-18","2019-05-11","2019-05-11","2019-08-09","2019-08-09","2019-08-08","2019-11-14","2019-02-04","2019-02-04","2019-02-04","2019-10-17","2019-08-09","2019-08-09","2019-08-22","2019-08-22","2019-10-17","2019-04-08","2019-08-09","2019-08-09"],"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":[["","00093314705","CEPHALEXIN ","CAP 500MG","15","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","20","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","",""],["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":""}]}]}