{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ASMA WARSAJI","gend":1,"add":"11256 CHESTER GARDEN CIRCLE                                 ","city":"CHESTER                       ","state":"VA","zip":"23831-1799","dob":"1991-02-18","age":"","mstatus":"","insh":10272453,"cliId":"","pno":8043257027,"cno":"","email":"","ename":"","eno":"","pphy":"BREEDEN, SARA ","ppno":"","pcpadd":"6439 Iron Bridge Rd","pcpcity":"North Chesterfield            ","pcpstate":"VA","pcpzip":232345205,"pcpcounty":"","pcpid":"P0118751","pcpname":"PRIMARY HEALTH GROUP","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"11256 CHESTER GARDEN CIRCLE                                 ","madd2":"                                                            ","madd3":"","mcity":"CHESTER                       ","mstate":"VA","mzip":"23831-1799","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["ASIAN\/PACIFIC"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.419","N83.209","Z31.69","B37.3","E03.9","R73.09","Z68.23","Z76.89","Z23","Z32.02","E55.9","Z13.79","Z3A.12","Z87.59"],"date":["2020-12-14","2020-12-14","2020-12-14","2020-12-14","2021-01-06","2020-12-30","2020-12-29","2020-12-30","2021-08-10","2021-07-12","2021-07-12","2021-10-26","2021-10-26","2021-10-26"],"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":{"comment":"","sub":[["","70710113908","FLUCONAZOLE","150MG","1","Select","Select",""],["","00536406301","CL","28-0.8MG","30","Select","Select",""],["","59779027408","ASPIRIN ","CHW 81MG","30","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","00536406301","CL ","TAB 28-0.8MG","30","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":""}]}]}