{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TERESA   G TOWNES","gend":1,"add":"PO BOX 522","city":"CASTLEWOOD","state":"VA","zip":"24224-9998","dob":"1967-10-08","age":"","mstatus":"","insh":"20036354*01","cliId":"","pno":"276\/762-5266","cno":"276\/762-5266","email":"","ename":"","eno":"","pphy":"BEVINS, ASHLEY DO","ppno":"276\/328-8910","pcpadd":"716 SPRING AVE SE SUITE 204","pcpcity":"WISE","pcpstate":"VA","pcpzip":24293,"pcpcounty":"","pcpid":152191,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"SOUTHWEST","aligned":"","ano":"276\/794-1974","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R60.9","I42.9","I10.","E66.01","E03.9","Z01.810","Z01.812","I72.4","Z48.812","Z98.890","H10.9","E11.49","E11.65","G25.81","K85.90","K86.9","K31.9","E16.2","G47.33","I73.9","N17.9","K85.92","K86.89","D64.9","E11.9","Z86.73","Z68.41","F17.210","R63.4","K59.00","E11.51","K21.9","E78.5","G47.30","I49.9","L02.425","L02.426","E11.22","I12.9","N18.31","M10.30","I70.0","I72.9","J20.9","Z87.09","N92.1","M54.9","Z48.00","I87.8","I69.351","M10.9","E87.6","E11.69","J01.90","R05.","L02.92","NO DATA","Z72.0","R73.9","Z79.899","I51.7","J30.9","J06.9","E11.59","R00.2","I49.3","C80.1","Z01.818","E66.9","Z90.710","Z79.82","Z79.84","N18.3"],"date":["2020-05-04","2021-06-01","2021-07-13","2021-07-12","2021-07-12","2021-07-13","2020-05-15","2021-07-13","2020-07-27","2020-07-27","2020-09-03","2021-06-01","2021-06-17","2021-03-19","2021-07-13","2021-07-10","2021-07-10","2021-07-10","2021-07-13","2021-07-13","2021-07-10","2021-07-18","2021-07-18","2021-07-12","2021-07-12","2021-07-12","2021-07-12","2021-07-13","2021-07-12","2021-07-13","2021-06-01","2020-08-04","2021-07-12","2020-06-23","2020-11-18","2021-06-01","2021-06-01","2021-06-01","2021-06-01","2021-06-01","2021-06-01","2021-06-01","2020-07-06","2021-01-05","2020-01-08","2020-07-06","2021-03-11","2021-02-05","2021-02-05","2021-02-05","2021-02-05","2021-02-05","2021-02-11","2021-02-11","2021-02-11","2021-06-02","2021-05-17","2021-05-26","2020-02-05","2020-11-18","2020-03-19","2021-05-26","2021-01-11","2021-07-12","2021-07-12","2021-07-13","2021-07-10","2021-07-14","2020-06-23","2020-06-23","2020-06-23","2020-06-23","2020-08-04"],"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":""}]}]}