{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WANDA   D JUDKINS","gend":1,"add":"214 FIELD STONE LN APT 202","city":"NEWPORT NEWS","state":"VA","zip":"23602-9998","dob":"1963-10-07","age":"","mstatus":"","insh":"20030440*01","cliId":"","pno":"909\/727-4290","cno":"909\/727-4290","email":"","ename":"","eno":"","pphy":"BECKWITH, DOUGLAS E MD","ppno":"804\/796-2373","pcpadd":"12901 BRIGGS RD","pcpcity":"CHESTER","pcpstate":"VA","pcpzip":23831,"pcpcounty":"","pcpid":106393,"pcpname":"","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":["K21.9","K59.00","I36.1","E11.9","I10.","E78.5","R42.","NO DATA","Z68.34","Z13.6","Z13.89","Z13.83","Z20.822","H40.013","H25.13","I25.110","I25.5","I48.0","R51.","R07.89","R05.","B34.9","E10.9","R39.81","I49.9","R07.9","I44.0","I49.3","R94.31","R41.3","E78.2","R10.84","R63.4","H40.003"],"date":["2021-01-04","2021-01-04","2020-03-06","2021-05-03","2020-12-14","2020-05-14","2020-05-14","2020-12-14","2020-05-14","2021-01-18","2021-01-18","2021-01-18","2021-01-18","2021-03-08","2021-03-08","2020-03-06","2020-03-16","2020-03-16","2020-03-07","2020-03-07","2021-01-07","2021-01-07","2020-05-26","2020-05-26","2020-03-05","2020-03-16","2020-03-07","2020-03-06","2021-01-07","2021-01-08","2020-12-14","2021-01-04","2021-01-04","2021-01-18"],"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":""}]}]}