{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TRINITY   K PRESTON","gend":1,"add":"119 INMAN STREET                                            ","city":"MARTINSVILLE                  ","state":"VA","zip":"24112-1307","dob":"2000-12-03","age":"","mstatus":"","insh":10206805,"cliId":"","pno":2767908175,"cno":2767908175,"email":"","ename":"","eno":"","pphy":"HUNDLEY, SUSAN D                                            ","ppno":"","pcpadd":"705 Main St,Ste 7","pcpcity":"Danville                      ","pcpstate":"VA","pcpzip":245411803,"pcpcounty":"","pcpid":"P0112785","pcpname":"HEALTH CENTER OF THE PIEDMONT MARTINSVILLE","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"APT 6                                                       ","add3":"","madd1":"119 INMAN STREET                                            ","madd2":"                                                            ","madd3":"","mcity":"MARTINSVILLE                  ","mstate":"VA","mzip":"24112-1307","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z11.3","Z36.85","Z39.1","Z34.82","Z34.83","Z3A.38","O09.73","O09.92","O80","Z37.0","Z3A.39","O70.1","J45.909","O99.824","Z41.2","M54.89","Z30.430","Z32.02","Z30.40","Z30.017","Z30.46","Z30.8","K21.00","R07.9","R11.0"],"date":["2020-02-27","2020-02-27","2020-02-27","2020-04-13","2020-04-13","2020-03-16","2020-03-16","2020-03-16","2020-03-25","2020-03-25","2020-03-25","2020-03-25","2020-03-25","2020-03-25","2020-03-27","2020-04-13","2020-05-11","2020-05-11","2020-10-29","2020-05-11","2020-10-29","2021-04-14","2021-11-13","2021-11-13","2021-11-13"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","",null,null,null]}},{"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":""}]}]}