{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DANNY   R MARTIN","gend":0,"add":"1280 ASTON RD","city":"VICTORIA","state":"VA","zip":"23974-9998","dob":"1949-05-23","age":"","mstatus":"","insh":"900044630*01","cliId":"1A47PQ3FG77","pno":"434\/676-3918","cno":"434\/676-3918","email":"","ename":"","eno":"","pphy":"PRUITT, DAVID E MD","ppno":"434\/315-5340","pcpadd":"935 SOUTH MAIN STREET","pcpcity":"FARMVILLE","pcpstate":"VA","pcpzip":23901,"pcpcounty":"","pcpid":182209,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"MA-NON DSNP","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R39.14","N99.89","D41.4","Z01.812","Z20.822","C67.2","D09.0","C67.9","I25.10","I10.","E78.5","E11.21","Z01.818","Z85.51","Z01.810","I49.3","E11.9","M54.9","M47.816","C67.4","N35.919","M48.061","M51.27","M51.26","E11.40","E78.00","E78.1","E11.65","Z79.899","Z79.02","Z79.82","Z95.5","I25.2","Z93.3","Z79.4","Z87.891","R30.0","R59.0","N18.2","E11.22","Z80.0","Z83.79","Z90.5","J43.9","R59.9","R31.9","R10.813","Z86.79","Z80.42"],"date":["2021-05-17","2021-04-05","2021-03-24","2021-05-05","2021-05-05","2021-05-10","2021-05-10","2021-07-20","2021-05-10","2021-05-10","2021-05-10","2021-05-10","2021-05-03","2021-03-23","2021-05-03","2021-05-03","2021-05-11","2021-06-03","2021-06-03","2021-03-23","2021-03-23","2021-06-03","2021-06-03","2021-06-03","2021-05-10","2021-05-10","2021-05-10","2021-05-10","2021-05-10","2021-05-10","2021-05-10","2021-05-10","2021-05-10","2021-05-10","2021-05-10","2021-05-10","2021-02-05","2021-06-10","2021-06-10","2021-06-10","2021-07-20","2021-06-10","2021-06-10","2021-06-08","2021-07-20","2021-07-20","2021-07-20","2021-07-20","2021-07-20"],"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":[["","057664037718","TRAMADOL ","50MG","21","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","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":""}]}]}