{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DARSHONELL   M HARDY","gend":0,"add":"1335 27TH ST","city":"NEWPORT NEWS","state":"VA","zip":"23607-9998","dob":"1982-12-09","age":"","mstatus":"","insh":"20028600*01","cliId":"","pno":"757\/470-1892","cno":"757\/470-1892","email":"","ename":"","eno":"","pphy":"LORENZO, DAVID L MD","ppno":"757\/380-8709","pcpadd":"4714 MARSHALL AVE","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23607,"pcpcounty":"","pcpid":510019,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"757\/766-9189","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":["V62.84","G43.909","Z91.09","F33.2","L93.2","L93.0","L29.8","Z79.899","B00.9","F14.20","F10.20","I10.","E55.9","K21.9","M19.90","F81.9","V58.89","Z01.89","R50.9","M54.5","R26.2","R51.","M25.511","R05.","H53.8","L08.9","F32.9","J31.0","L29.9","S81.811A","R10.32","R10.31","R03.0","F29.","R10.30","K60.2","R19.5","R19.7","R10.33","K59.00","M54.9","Z23.","H44.009","M54.6","Z76.0","H57.11","R21.","R52.","M25.512","F14.10","J30.2","S21.212A","R10.84","R11.2","R51.9","S32.010A","Z91.19","R10.9","S29.012A","S89.91XA","M79.661","W11.XXXA","Y92.9","R11.10","R53.81"],"date":["2021-07-09","2021-07-10","2021-07-10","2021-07-14","2020-04-22","2020-07-23","2020-04-22","2020-07-23","2020-05-26","2021-07-09","2021-07-09","2021-07-26","2021-07-09","2021-07-09","2021-07-09","2021-07-09","2021-07-09","2021-07-16","2021-07-16","2020-02-25","2020-02-08","2020-07-05","2021-07-13","2021-07-26","2020-05-22","2021-07-26","2021-07-26","2021-07-26","2021-07-26","2020-07-17","2021-07-05","2021-07-05","2021-07-05","2020-07-05","2021-01-29","2021-01-29","2021-01-29","2021-01-29","2021-01-29","2021-01-29","2021-07-26","2021-02-05","2021-07-26","2021-04-23","2021-04-23","2020-01-24","2021-07-26","2020-06-25","2020-06-25","2020-06-21","2020-07-05","2021-04-12","2021-06-28","2021-06-28","2021-07-26","2020-02-08","2020-07-23","2021-06-28","2020-01-23","2020-07-17","2020-07-17","2020-07-17","2020-07-17","2021-06-28","2021-06-28"],"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","",""],["No","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":""}]}]}