{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROSLYN WATKINS","gend":1,"add":"2221 GEORGETOWN BLVD","city":"CHESAPEAKE","state":"VA","zip":"23325-9998","dob":"1956-12-20","age":"","mstatus":"","insh":"2326797*01","cliId":"","pno":"510\/851-0871","cno":"510\/851-0871","email":"","ename":"","eno":"","pphy":"ANTOINE, ANGELA DO","ppno":"757\/424-4442","pcpadd":"6632 INDIAN RIVER RD STE 104","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23464,"pcpcounty":"","pcpid":122066,"pcpname":"Nowcare Medical Associates","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/202-1212","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/523-4765","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I82.409","M32.9","E78.5","Z13.1","Z86.718","M25.512","M75.32","I82.403","Z98.890","H20.9","F17.200","Z01.30","R68.89","L81.9","D64.9","R20.1","Z01.419","Z12.31","H02.59","R76.0","Z12.11","R87.612","H25.13","H20.042","H52.539","A60.9","N87.9","N90.89","Z12.12"],"date":["2020-10-16","2021-08-05","2021-05-28","2021-05-28","2020-12-07","2020-12-07","2021-08-05","2020-12-09","2020-12-09","2020-12-09","2020-12-09","2020-12-09","2020-12-09","2020-12-09","2021-06-23","2021-06-03","2021-07-19","2021-07-19","2021-06-23","2021-10-07","2021-07-06","2021-08-11","2021-08-06","2021-08-06","2021-08-06","2021-07-22","2021-07-22","2021-07-22","2021-02-04"],"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":[["","59267100003","PFIZER","COVID-19","0","Select","Select",""],["","59267100003","PFIZER ","INJ COVID-19","0","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","",""],["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":""}]}]}