{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" CALVIN LEONARD","gend":0,"add":"19309 VARANDA LANE","city":"SOUTH CHESTERFI","state":"VA","zip":"23834-5621","dob":"1951-01-20","age":"","mstatus":"","insh":10271146,"cliId":"","pno":"8043187415, 8043187451","cno":8043187415,"email":"","ename":"","eno":"","pphy":"AHMED, IRSHAD","ppno":"               ","pcpadd":"2801 Boulevard Ste B, ","pcpcity":"Colonial Heights","pcpstate":"VA","pcpzip":238342323,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"19309 VARANDA LANE","madd2":"                                                            ","madd3":"","mcity":"SOUTH CHESTERFI","mstate":"VA","mzip":"23834-5621","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R07.9","I48.0","I42.0","C34.01","I48.91","R06.00","Z85.118","H25.013","H04.123","R00.2","Z79.899","Z88.6","H02.055","H02.825","H35.3131","R07.89","Z53.20","Z87.891","Z79.01","J98.4","I49.9"],"date":["2020-12-27","2020-12-18","2020-12-18","2020-12-01","2020-12-27","2020-12-06","2020-12-06","2021-05-18","2021-05-18","2020-12-27","2020-12-27","2020-12-27","2021-04-20","2021-04-20","2021-04-20","2020-12-06","2020-12-27","2020-12-27","2020-12-27","2020-12-27","2020-12-11"],"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":[["","00597007541","SPIRIVA ","CAP HANDIHLR","30","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","49884090738","MEGESTROL ","SUS 40MG\/ML","600","Select","Select",""],["","50742061710","METOPROL ","TAB 100MG ER","30","Select","Select",""],["","68180051201","LISINOPRIL ","TAB 2.5MG","30","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","00003089421","ELIQUIS ","TAB 5MG","60","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","",""],["Yes","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":""}]}]}