{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GABRIELLE BOSTIC","gend":1,"add":"1100   FRANK HOLLOW ROAD                                    ","city":"GRUNDY                        ","state":"VA","zip":"24614-6995","dob":"1997-06-10","age":"","mstatus":"","insh":10169638,"cliId":"","pno":2769714741,"cno":"","email":"","ename":"","eno":"","pphy":"SUTHERLAND, JOSHUA P                                        ","ppno":"","pcpadd":"20886 Riverside Dr","pcpcity":"Grundy                        ","pcpstate":"VA","pcpzip":246149597,"pcpcounty":"","pcpid":"P9120112","pcpname":"BUCHANAN HEALTH CARE LLC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"1100   FRANK HOLLOW ROAD                                    ","madd2":"                                                            ","madd3":"","mcity":"GRUNDY                        ","mstate":"VA","mzip":"24614-6995","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z11.1","Z39.1","Z34.82","Z34.83","O28.3","O43.90","O36.8120","Z3A.23","Z36.3","Z3A.25","Z34.02","R73.09","O24.420","Z23","N39.0","O60.03","Z3A.34","R10.9","M54.5","Z3A.37","Z37.0","O69.2XX0","O70.0","Z3A.38","O60.23X0","K92.1","K64.2","F32.9","Z13.818","H81.11","R73.01","R53.83","Z00.8","Z71.89","Z13.89","Z13.9","R55","I95.9","R42","F43.22","R45.89","Z63.0","R50.9","M71.342","Z02.0","Z20.828","R63.4","R79.0","G47.09","F33.0","F41.1","M94.0","Z20.822","R07.9","O90.3","N76.0","Z32.01","Z11.3","N91.2","O02.1","Z3A.00","Z3A.01","O36.80X0"],"date":["2020-05-14","2019-05-21","2019-06-18","2019-09-04","2019-08-07","2019-05-24","2019-05-25","2019-05-25","2019-06-05","2019-06-05","2019-06-18","2019-06-21","2019-09-04","2019-07-24","2019-07-31","2019-08-12","2019-08-12","2019-08-12","2019-08-30","2019-08-30","2019-09-05","2019-09-04","2019-09-04","2019-09-05","2019-09-05","2019-10-22","2019-10-22","2020-04-29","2019-12-03","2019-12-04","2019-12-04","2021-03-17","2019-12-03","2020-02-13","2020-04-29","2020-04-29","2020-06-09","2020-06-09","2019-12-18","2020-04-29","2020-01-10","2020-04-29","2020-02-13","2020-02-13","2020-05-07","2020-12-31","2021-02-16","2021-03-17","2021-02-16","2021-02-16","2021-02-16","2021-02-25","2021-02-25","2021-02-25","2021-03-17","2021-04-01","2021-03-31","2021-04-01","2021-04-21","2021-05-20","2021-05-05","2021-04-21","2021-04-21"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",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","",""],["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":""}]}]}