{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ERNEST JOHNSTON","gend":0,"add":"116 DIGGSTOWN ROAD","city":"BUMPASS","state":"VA","zip":"23024-3729","dob":"1978-05-14","age":"","mstatus":"","insh":10180530,"cliId":"","pno":8048339663,"cno":8048339663,"email":"","ename":"","eno":"","pphy":"COOK, JAMES S","ppno":8047629646,"pcpadd":"2105 E Parham Rd Ste 109, ","pcpcity":"Henrico","pcpstate":"VA","pcpzip":232282236,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"116 DIGGSTOWN ROAD","madd2":"                                                            ","madd3":"","mcity":"BUMPASS","mstate":"VA","mzip":"23024-3729","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J98.4","R41.82","S22.21XA","V43.52XA","F17.213","S22.31XA","S22.32XA","F14.10","I34.0","Z04.3","V89.2XXA","S19.9XXA","R55","S00.03XA","S29.9XXA","S39.93XA","S22.20XA","V89.0XXA","J98.11","J69.0","S22.039A","S32.019A","S22.43XA","S26.90XA","S22.089A","F14.90","F17.210","F41.1","J45.909","F32.9","R06.02","R07.9","R00.0","J69.8","S82.234A","T14.90XA","V49.40XA","I51.7","R91.8","S22.41XA","S39.91XA","S22.088A","S32.018A"],"date":["2019-11-08","2019-11-08","2019-11-07","2019-11-07","2019-11-05","2019-11-11","2019-11-07","2019-11-05","2019-11-09","2019-11-05","2019-11-05","2019-11-07","2019-11-05","2019-11-05","2019-11-05","2019-11-07","2019-11-11","2019-11-11","2019-11-11","2019-11-07","2019-11-07","2019-11-07","2019-11-07","2019-11-07","2019-11-07","2019-11-07","2019-11-07","2019-11-07","2019-11-07","2019-11-07","2019-11-07","2019-11-07","2019-11-07","2019-11-07","2019-11-07","2019-11-07","2019-11-07","2019-11-07","2019-11-10","2019-11-07","2019-11-07","2019-11-07","2019-11-07"],"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":[]}},{"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":""}]}]}