{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EVETTE   M ROBINSON","gend":1,"add":"2425 GOSNOLD AVE APT 106","city":"NORFOLK","state":"VA","zip":"23517-9998","dob":"1965-01-16","age":"","mstatus":"","insh":"20002832*01","cliId":"","pno":"757\/352-0313","cno":"757\/352-0313","email":"","ename":"","eno":"","pphy":"MARKOVIC, VLADIMIR MD","ppno":"757\/393-6363","pcpadd":"3415 GRANBY STREET","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23504,"pcpcounty":"","pcpid":102266,"pcpname":"Park Place Family Medical Center","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"757\/805-8972","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":["V58.89","Z48.00","I87.332","I89.0","L03.116","S81.802A","R07.9","N17.0","E87.2","N39.0","N17.9","E87.5","R79.1","E11.69","A41.51","R65.20","D50.9","E66.01","A41.9","J45.909","E11.9","K21.9","Z68.44","Z79.01","Z91.81","J96.01","I10.","R65.21","I27.20","L03.90","I87.322","I82.409","E66.9","I26.99","E13.9","Z68.43","I50.31","I50.9","Z86.711","J45.41","D72.829","R53.81","R53.83","R06.02","M79.605","I51.89","I73.9","E87.1","D64.9","R42.","R07.89","Z32.00","R53.1","R26.9","Z78.9","Z79.899","Z86.718","E87.6","R60.9"],"date":["2020-10-21","2020-10-21","2020-08-17","2021-07-19","2021-07-20","2021-02-15","2020-11-24","2021-07-20","2020-12-01","2021-03-08","2021-07-07","2021-03-08","2020-12-04","2020-12-04","2020-12-22","2020-12-04","2021-01-13","2021-07-20","2021-07-20","2021-03-08","2021-07-20","2021-03-08","2021-07-20","2021-07-07","2021-03-08","2021-07-20","2021-07-20","2021-07-20","2021-07-08","2021-05-18","2020-07-29","2021-05-18","2021-05-18","2021-05-18","2021-06-08","2021-06-08","2021-07-07","2021-07-16","2021-07-07","2021-07-07","2021-07-18","2020-11-24","2020-11-24","2021-07-07","2021-07-08","2020-11-25","2020-07-09","2020-11-25","2020-11-25","2020-12-02","2020-12-04","2021-05-18","2020-12-01","2020-12-01","2020-12-01","2021-01-08","2021-01-08","2021-01-08","2021-01-08"],"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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}