{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VERONICA CALIXTO","gend":1,"add":"175   WHITE PINE CIRCLES                                    ","city":"STAFFORD                      ","state":"VA","zip":"22554-9414","dob":"1976-09-09","age":"","mstatus":"","insh":10179814,"cliId":"","pno":9788754275,"cno":"","email":"","ename":"","eno":"","pphy":"ANBESSIE, TEDLA B                                           ","ppno":"","pcpadd":"2146 Jefferson Davis Hwy","pcpcity":"Stafford                      ","pcpstate":"VA","pcpzip":225547223,"pcpcounty":"","pcpid":"P9443127","pcpname":"AQUIA FAMILY MEDICAL CENTER","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"APT 201                                                     ","add3":"","madd1":"175   WHITE PINE CIRCLES                                    ","madd2":"APT 201                                                     ","madd3":"","mcity":"STAFFORD                      ","mstate":"VA","mzip":"22554-9414","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S09.90XA","M54.5","V89.2XXA","Y92.411","R07.89","K52.9","N12","M50.30","F32.9","F41.9","Z85.3","Z88.1","R07.9","R91.8","S19.9XXA","R10.9","R93.3","T14.8XXA","M54.6","M54.9","F34.1"],"date":["2019-05-26","2019-05-26","2019-05-26","2019-05-26","2019-05-26","2019-05-26","2019-05-26","2019-05-26","2019-05-26","2019-05-26","2019-05-26","2019-05-26","2019-05-26","2019-05-26","2019-05-26","2019-05-26","2019-05-26","2019-05-26","2019-05-26","2019-07-25","2019-07-25"],"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":[]},{"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":""}]}]}