{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PATRICIA   L FRANKLIN","gend":1,"add":"2813 KULMAN PL APT B","city":"LYNCHBURG","state":"VA","zip":"24501-9998","dob":"1968-03-02","age":"","mstatus":"","insh":"20027519*01","cliId":"","pno":"704\/756-2491","cno":"704\/756-2491","email":"","ename":"","eno":"","pphy":"NELSON MADISON, LORI MD","ppno":"434\/200-5200","pcpadd":"2323 MEMORIAL DR","pcpcity":"LYNCHBURG","pcpstate":"VA","pcpzip":24501,"pcpcounty":"","pcpid":165800,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"WESTERN\/ CHARLOTTESVILLE","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":["E11.42","M79.671","M79.672","N95.0","M54.5","M54.16","M47.816","Z51.81","Z79.891","G47.33","S20.212A","E11.51","E78.5","Z79.84","W10.8XXA","Z72.0","L29.9","I10.","G47.00","H66.92","A59.9","N89.8","J06.9","S91.331A","J32.9","H60.92"],"date":["2021-07-23","2021-07-23","2021-07-23","2020-02-12","2021-05-03","2021-05-03","2021-05-03","2021-05-03","2021-05-03","2021-01-29","2020-10-16","2020-10-16","2020-10-16","2020-10-16","2020-10-16","2021-05-19","2021-05-19","2020-02-06","2020-02-06","2020-02-18","2020-01-07","2020-01-07","2020-01-07","2020-07-12","2020-02-27","2020-02-27"],"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":""}]}]}