{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KEITH BANKS","gend":0,"add":"609   LANCER DRIVE                                          ","city":"PORTSMOUTH                    ","state":"VA","zip":"23701-2144","dob":"1994-04-26","age":"","mstatus":"","insh":10193962,"cliId":"","pno":7576750145,"cno":7576750145,"email":"","ename":"","eno":"","pphy":"BOWERS, JESSICA A                                           ","ppno":"","pcpadd":"1040 University Blvd Ste 205","pcpcity":"Portsmouth                    ","pcpstate":"VA","pcpzip":237032650,"pcpcounty":"","pcpid":"P0060014","pcpname":"TRI CITIES MEDICAL ASSOCIATES","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"TIDEWATER","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"609   LANCER DRIVE                                          ","madd2":"                                                            ","madd3":"","mcity":"PORTSMOUTH                    ","mstate":"VA","mzip":"23701-2144","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G89.29","K08.9","L65.9","K08.89","R21","F17.210","S05.02XA","H57.12","X58.XXXA","J45.909","F17.200"],"date":["2019-08-28","2019-08-28","2019-08-28","2019-08-28","2019-08-28","2019-08-28","2020-12-27","2020-12-27","2020-12-27","2020-12-27","2020-12-27"],"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":[["","69315030805","CIPROFLOXACN","0.3% OP","5","Select","Select",""],["","60758077305","KETOROLAC","0.40%","5","Select","Select",""],["","65162046650","IBUPROFEN","800MG","30","Select","Select",""],["","65162003310","APAP\/CODEINE","300-30MG","15","Select","Select",""],["","69315030805","CIPROFLOXACN ","SOL 0.3% OP","5","Select","Select",""],["","60758077305","KETOROLAC ","SOL 0.004","5","Select","Select",""],["","65162046650","IBUPROFEN ","TAB 800MG","30","Select","Select",""],["","65162003310","APAP\/CODEINE ","TAB 300-30MG","15","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","",""],["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":""}]}]}