{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NATASIA HOLLAND","gend":1,"add":"17 CORNELIUS DR APT 22","city":"HAMPTON","state":"VA","zip":"23666-9998","dob":"2003-07-28","age":"","mstatus":"","insh":"1429510*01","cliId":"","pno":"757\/975-1429","cno":"757\/975-1429","email":"","ename":"","eno":"","pphy":"STAPLETON, MACY LERIN NP","ppno":"757\/838-8166","pcpadd":"2101 EXECUTIVE DRIVE SUITE 160","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":209199,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","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":["Z30.40","M54.89","F43.10","N39.0","R53.83","R10.9","N76.0","Z73.3","Z72.820","N89.8","Z11.3","Z11.4","B37.3","Z32.02","R40.4","R51.9","R31.9","Z11.1","Z30.42","F32.89","F45.22","R11.0","Z72.51","Z30.9","R50.9","R05.","R51.","NO DATA","R09.81","Z30.46","L29.2","N93.8","R30.0","Z30.09","Z01.419","N92.0","Z23.","J30.9","F32.1","Z13.31","Z00.129","Z71.82","Z76.89","Z71.3","Z68.52","N91.2","Z70.8","Z30.013","Z30.41"],"date":["2020-08-18","2020-11-06","2021-07-26","2021-05-11","2021-05-11","2021-05-11","2021-05-11","2021-05-11","2021-05-11","2021-05-13","2021-03-24","2020-03-10","2021-03-24","2021-07-06","2021-06-01","2021-07-08","2021-06-01","2021-07-06","2021-01-25","2021-03-23","2021-03-23","2021-07-08","2021-04-08","2021-04-08","2020-02-11","2020-02-11","2020-02-11","2020-02-11","2020-02-11","2020-08-25","2021-05-13","2021-05-13","2021-05-13","2021-05-13","2020-09-18","2021-03-03","2021-03-03","2021-03-03","2021-03-03","2021-03-03","2020-08-07","2020-08-07","2020-08-07","2020-08-07","2020-08-07","2020-08-07","2020-08-07","2020-10-29","2021-07-08"],"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":[]},{"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":""}]}]}