{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DARLENE   R GRAHAM","gend":1,"add":"3231 VIMY RIDGE AVE APT B","city":"NORFOLK","state":"VA","zip":"23509-9998","dob":"1960-10-05","age":"","mstatus":"","insh":"20028078*01","cliId":"","pno":"757\/493-9436","cno":"757\/493-9436","email":"","ename":"","eno":"","pphy":"BICE, HAMILTON L DO","ppno":"757\/395-6630","pcpadd":"STE 200 1080 FIRST COLONIAL RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":117381,"pcpname":"Cape Charles Medical Center","plan":"OHP","program":"MEDICAID","lob":"OHCC","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":["S61.210A","S61.212A","T40.601A","M54.16","F11.20","Z00.00","Z12.31","I10.","E78.2","F33.0","K21.9","E03.9","G89.29","E65.","M25.562","M46.1","M54.5","M54.6","R10.10","R19.7","Z87.891","D50.0","F32.9","Z87.19","Z98.84","Z86.39","Z88.6","Z88.1","Z86.69","Z79.890","Z79.899","F51.04","G47.00","K58.1","Z12.39","G89.4","V58.89"],"date":["2020-03-18","2020-03-18","2020-05-09","2021-07-13","2020-09-28","2021-07-22","2021-07-22","2021-07-22","2021-07-22","2021-07-22","2021-07-22","2021-07-22","2021-07-22","2021-07-22","2021-07-22","2021-07-13","2021-07-13","2021-07-13","2020-10-22","2020-10-22","2020-10-22","2020-01-13","2020-03-15","2020-03-15","2020-05-15","2020-03-15","2020-03-15","2020-03-15","2020-03-15","2020-03-15","2020-03-15","2020-05-15","2020-05-15","2020-05-15","2020-05-15","2020-04-16","2020-04-01"],"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":""}]}]}