{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EMMANUEL   C WAGSTAFF","gend":0,"add":"1713 GLENN ST","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"1981-07-26","age":"","mstatus":"","insh":"900047861*01","cliId":"1WR8ET5RV40","pno":"434\/441-1563","cno":"434\/441-1563","email":"","ename":"","eno":"","pphy":"TRIVEDI, RAJENDRA MD","ppno":"434\/792-3730","pcpadd":"STE 120 501 RISON ST","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":117489,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"434\/483-1445","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/792-6048","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L97.512","L97.525","E10.621","L97.412","L97.422","I12.0","E10.22","N18.6","Z99.2","L84.","Z83.3","Z20.828","I10.","E11.65","L97.522","E11.51","Z13.89","E87.70","E83.39","D50.9","D63.1","D68.8","N25.81","Z79.4","Z49.31","N18.9","E11.22","Z23."],"date":["2021-06-24","2021-05-06","2021-07-02","2021-06-24","2021-07-02","2021-07-02","2021-07-02","2021-10-01","2021-10-01","2021-07-02","2021-07-02","2021-05-24","2021-07-03","2021-07-03","2021-07-02","2021-05-04","2021-05-04","2021-10-01","2021-10-01","2021-10-01","2021-10-01","2021-09-30","2021-10-01","2021-07-02","2021-08-31","2021-10-01","2021-10-01","2021-09-30"],"priorHcc":["","","","","","","",null,null,"","","","","","","","",null,null,null,null,null,null,"",null,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":[["","59922063101","AURYXIA ","","270","Select","Select",""],["","59922063101","AURYXIA","","270","Select","Select",""],["","59922063101","AURYXIA                                                               ","TAB 210MG","270","Select","Select",""],["","64380073706","VITAMIN D                                                             ","CAP 50000UNT","4","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","",""],["No","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":""}]}]}