{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHANIQWA   M AVERY","gend":1,"add":"2520 FAIRFIELD AVE.","city":"RICHMOND","state":"VA","zip":"23223-4128","dob":"1992-02-20","age":"","mstatus":"","insh":7725035,"cliId":"","pno":8044411023,"cno":8044411023,"email":"","ename":"","eno":"","pphy":"COVINGTON, DAMIAN L","ppno":8042257177,"pcpadd":"11020 HULL STREET RD, ","pcpcity":"MIDLOTHIAN","pcpstate":"VA","pcpzip":231123200,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"2520 FAIRFIELD AVE.","madd2":"                                                            ","madd3":"","mcity":"RICHMOND","mstate":"VA","mzip":"23223-4128","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O04.6","T80.61XA","L23.89","R68.83","R00.0","R06.82","O20.9","Z3A.00","Z20.828","S69.92XA","D06.9","O02.9","I95.9","S60.052A","M79.645","W23.0XXA","I10","F17.200","Y93.E6","Z01.419","B00.9","N89.8","O03.0","O03.37","A41.9","D62","T80.92XA","O03.89","O16.4","O99.02","O99.334","O9A.22","F17.210","Y84.8","Z88.1","Z76.89","N30.00","M54.5","Z72.51","Z11.3","Z86.79","Z13.21","Z13.29","Z92.89","I49.9","R53.1","N93.9","R11.0","R23.2","R50.9","I51.7","R94.31","O03.9"],"date":["2019-04-13","2020-09-03","2020-09-03","2020-09-03","2020-09-03","2020-09-03","2020-08-30","2020-08-30","2021-01-26","2019-01-21","2020-09-03","2020-09-03","2020-09-03","2019-01-21","2019-01-21","2019-01-21","2019-01-21","2019-01-21","2019-01-21","2020-06-19","2020-06-19","2020-06-19","2020-09-03","2020-09-03","2020-09-03","2020-09-03","2020-09-03","2020-09-03","2020-09-03","2020-09-03","2020-09-03","2020-09-03","2020-09-03","2020-09-03","2020-09-03","2020-06-12","2020-06-12","2020-06-12","2020-06-12","2020-06-12","2020-06-12","2020-06-12","2020-06-12","2020-06-12","2020-09-02","2020-09-02","2020-09-02","2020-09-02","2020-09-02","2020-09-03","2020-09-03","2020-09-03","2020-08-30"],"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":[["","67877032105","IBUPROFEN ","TAB 800MG","30","Select","Select",""],["","59762007301","HYDROCORT ","TAB 5MG","30","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","57237000511","FLUCONAZOLE ","TAB 150MG","2","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","",""],["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":""}]}]}