{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"YVETTE NELSON-MILES","gend":1,"add":"5636   VINIA PORT COURTS                                    ","city":"VIRGINIA BEACH                ","state":"VA","zip":"23464-9998","dob":"1990-04-18","age":"","mstatus":"","insh":10173496,"cliId":"","pno":5713382755,"cno":4433063738,"email":"","ename":"","eno":"","pphy":"MOHAN, RAVINDER                                             ","ppno":"","pcpadd":"825 Fairfax Ave","pcpcity":"Norfolk                       ","pcpstate":"VA","pcpzip":235071914,"pcpcounty":"","pcpid":"P9059051","pcpname":"SENTARA FAMILY MED PRIMARY CARE","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"TIDEWATER","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"5636 ZINIA CT                                               ","madd2":"                                                            ","madd3":"","mcity":"VIRGINIA BEACH                ","mstate":"VA","mzip":"23464-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z34.80","Z34.92","O46.90","Z3A.16","O26.892","H53.9","R55","Z3A.19","H53.453","Z3A.21","H53.459","O99.89","G45.3","Z3A.22","O35.9XX0","Z3A.24","R68.89","Z3A.31","O26.893","R00.2","H53.8","Z3A.32","O60.03","Z3A.34","Z34.93","Z3A.36","R10.2","O12.03","O09.13","Z3A.38","Z90.79","O26.62","K83.1","Z37.0","Z3A.39","O76","O80","J06.9","M62.08","L98.7","K42.9","M79.604","M79.661","R20.0","R20.2","Z01.419","L70.0","L81.0","M25.511","M54.2","R51.9","W10.9XXA","M79.18"],"date":["2019-04-02","2019-05-08","2019-05-31","2019-04-02","2019-04-22","2019-04-22","2019-07-26","2019-04-22","2019-05-16","2019-05-08","2019-05-16","2019-05-16","2019-05-16","2019-05-16","2019-05-31","2019-05-31","2019-05-31","2019-07-18","2019-08-23","2019-07-26","2019-07-26","2019-07-26","2019-08-06","2019-08-06","2019-08-22","2019-08-23","2019-08-23","2019-09-02","2019-09-02","2019-09-02","2019-09-11","2019-09-11","2019-09-11","2019-09-12","2019-09-12","2019-09-11","2019-09-12","2019-10-12","2019-11-14","2020-01-13","2021-02-15","2020-08-07","2020-08-07","2020-08-07","2020-08-07","2020-09-04","2020-09-24","2020-09-24","2021-05-31","2021-05-31","2021-05-31","2021-05-31","2021-05-31"],"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":[["","53489011905","DOXYCYCL","100MG","30","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","30","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":""}]}]}