{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TERRY JOHNSON","gend":0,"add":"265 N MAIN ST APT 323","city":"HARRISONBURG","state":"VA","zip":"22802-9998","dob":"1964-03-16","age":"","mstatus":"","insh":"20030120*01","cliId":"","pno":"540\/607-5803","cno":"540\/607-5803","email":"","ename":"","eno":"","pphy":"RICE, GILBERT C DO","ppno":"540\/234-9241","pcpadd":"1151 KEEZLETOWN RD SUITE 101","pcpcity":"WEYERS CAVE","pcpstate":"VA","pcpzip":24486,"pcpcounty":"","pcpid":147705,"pcpname":"Carilion Family Medicine - Weyers Cave","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"540\/208-8417","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":["D48.5","L21.8","R11.2","R19.7","L71.8","K76.6","Z79.899","Z98.890","R74.8","F41.1","F25.9","F33.2","NO DATA","R21.","F25.1","J18.9","Z20.828","Z86.19","R03.0","Z11.3","L71.9","N52.9","F52.8","L70.0","K74.00","D72.825","K76.0"],"date":["2020-01-09","2021-02-08","2021-06-22","2021-06-22","2021-02-08","2020-08-25","2020-08-25","2020-08-25","2020-08-25","2021-01-20","2021-01-20","2021-01-20","2021-01-20","2020-01-31","2021-06-17","2020-09-21","2020-09-21","2020-01-29","2020-01-29","2020-01-29","2020-01-29","2020-05-28","2020-11-03","2020-06-15","2021-06-30","2021-06-30","2021-06-30"],"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","",""],["No","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":""}]}]}