{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"REGINA DANIELS","gend":1,"add":"16   CLAYTON  DRIVE                                         ","city":"HAMPTON                       ","state":"VA","zip":"23669-2904","dob":"1983-11-25","age":"","mstatus":"","insh":10185030,"cliId":"","pno":7572272117,"cno":7572272117,"email":"","ename":"","eno":"","pphy":"BOWERS, LEO C                                               ","ppno":"","pcpadd":"26 WINE STREET","pcpcity":"HAMPTON                       ","pcpstate":"VA","pcpzip":236693584,"pcpcounty":"","pcpid":"P0060337","pcpname":"PENINSULA INSTITUTE FOR COMMUNITY HEALTH INC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"TIDEWATER","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"16   CLAYTON  DRIVE                                         ","madd2":"                                                            ","madd3":"","mcity":"HAMPTON                       ","mstate":"VA","mzip":"23669-2904","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R73.02","O99.213","O34.219","Z36.3","Z3A.29","O09.292","O24.419","Z86.32","O26.893","R03.0","E66.01","O09.523","Z3A.31","Z87.891","Z79.899","O09.93","Z71.3","O36.5930","Z3A.32","R68.89","O09.529","Z3A.30","O26.853","R10.2","M25.559","Z3A.34","O26.899","N93.9","O26.90","Z3A.37","Z3A.38","F33.1","H66.003","H92.03","Z3A.39","R52","O10.011","Z30.2","O24.410","Z37.0","O34.211","O10.92","O98.813","D62","O72.1","O99.214","O99.013","B95.1","O99.613","K21.9","O99.343","Z3A.00","Z00.00","G89.18","O41.1230","Z37.9","F33.9","S49.91XA","M77.8","W01.198A","Y93.E2","Y92.019","M54.12","F17.210","E66.9","Z68.43","Z82.49","M54.10"],"date":["2019-06-04","2019-08-16","2019-08-21","2019-06-13","2019-06-14","2019-06-14","2019-08-21","2019-06-21","2019-08-18","2019-06-21","2019-08-21","2019-08-20","2019-06-28","2019-06-21","2019-06-21","2019-06-28","2019-06-28","2019-08-06","2019-07-02","2019-11-08","2019-08-21","2019-07-16","2019-07-22","2019-07-22","2019-07-22","2019-07-22","2019-07-22","2019-07-22","2019-07-22","2019-08-09","2019-08-16","2020-03-13","2019-08-18","2019-08-18","2019-08-21","2019-08-18","2019-08-21","2019-08-30","2019-08-21","2019-08-21","2019-08-21","2019-08-21","2019-08-21","2019-08-21","2019-08-21","2019-08-21","2019-08-21","2019-08-21","2019-08-21","2019-08-21","2019-08-21","2019-08-21","2019-08-21","2019-08-22","2019-08-30","2019-08-30","2020-12-01","2021-08-04","2021-08-04","2021-08-04","2021-08-04","2021-08-04","2021-08-04","2021-08-04","2021-08-04","2021-08-04","2021-08-04","2021-08-04"],"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":[["","59676058015","JANSSEN","COVID-19","0.5","Select","Select",""],["","59676058015","JANSSEN ","INJ COVID-19","0.5","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":""}]}]}