{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DE'QUAN   D BERKLEY","gend":0,"add":"3331 INDIAN OAK ROAD                                        ","city":"CREWE                         ","state":"VA","zip":"23930-3024","dob":"1990-04-02","age":"","mstatus":"","insh":10256801,"cliId":"","pno":4346032805,"cno":4346032805,"email":"","ename":"","eno":"","pphy":"TRAN, GEORGE M                                              ","ppno":"","pcpadd":"412 Namozine St","pcpcity":"Burkeville                    ","pcpstate":"VA","pcpzip":239223184,"pcpcounty":"","pcpid":"P9058482","pcpname":"CENTRA SOUTHSIDE PROFESSIONAL LLC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"3331 INDIAN OAK ROAD                                        ","madd2":"                                                            ","madd3":"","mcity":"CREWE                         ","mstate":"VA","mzip":"23930-3024","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F10.239","E87.6","F41.9","J45.909","Z72.0","Z79.51","R25.1","F10.10","Z78.9","Z72.89"],"date":["2020-12-11","2021-06-29","2021-06-29","2021-06-29","2021-06-29","2020-12-11","2020-12-11","2020-12-17","2020-12-17","2021-06-29"],"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":[["","00186037020","SYMBICORT","160-4.5","10.2","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","61442010310","DICLOFENAC","75MG DR","60","Select","Select",""],["","69315090510","LORAZEPAM","1MG","10","Select","Select",""],["","23155002401","BUSPIRONE","10MG","60","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","00186037020","SYMBICORT ","AER 160-4.5","10.2","Select","Select",""],["","00173068220","VENTOLIN ","AER ","18","Select","Select",""],["","61442010310","DICLOFENAC ","TAB 75MG DR","60","Select","Select",""],["","69315090510","LORAZEPAM ","TAB 1MG","10","Select","Select",""],["","23155002401","BUSPIRONE ","TAB 10MG","60","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","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":""}]}]}