{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DAWN BONAPARTE","gend":1,"add":"2715 HANES AVE","city":"RICHMOND","state":"VA","zip":"23222-9998","dob":"1965-11-15","age":"","mstatus":"","insh":"20004341*01","cliId":"","pno":"804\/528-9272","cno":"804\/528-9272","email":"","ename":"","eno":"","pphy":"GREEN JR, HAROLD T MD","ppno":"804\/644-1665","pcpadd":"STE 308 1510 N 28TH ST","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23223,"pcpcounty":"","pcpid":208009,"pcpname":"PRIMARY HEALTHCARE ASSOCIATES","plan":"OHP","program":"MEDICAID","lob":"OHCC","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":["M26.71","M26.79","K02.9","R25.2","I10.","Z86.73","D63.8","C50.912","C77.3","R92.8","Z68.28","Z85.3","NO DATA","C50.211","Z15.01","Z17.1","Z15.09","L76.32","Z90.13","M96.841","I95.9","R00.0","Z92.21","Z87.891","I69.354","E87.79","C50.911","N64.59","D50.0","E78.00","E55.9","Z68.34"],"date":["2020-05-12","2020-05-12","2020-05-12","2020-05-28","2021-07-20","2021-07-20","2021-07-20","2021-07-20","2021-07-20","2020-06-26","2020-06-26","2021-04-05","2020-06-26","2021-04-05","2021-04-05","2021-04-05","2021-04-05","2020-09-04","2021-04-05","2020-09-04","2020-09-04","2020-09-04","2020-09-04","2020-09-04","2020-09-04","2020-09-04","2020-09-04","2020-09-04","2020-09-05","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":[]},{"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","",""],["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":""}]}]}