{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARY   L NORMAN","gend":1,"add":"2785 WILROY RD","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1954-04-04","age":"","mstatus":"","insh":"20040853*01","cliId":"","pno":"757\/809-0621","cno":"757\/809-0621","email":"","ename":"","eno":"","pphy":"BEVERLY, VERNIS MD","ppno":"757\/484-2001","pcpadd":"STE A 3800 POPLAR HILL RD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23321,"pcpcounty":"","pcpid":128565,"pcpname":"Adult and Pediatric Medical Associates","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":["J44.9","I50.9","J81.1","G47.33","M79.673","M19.90","I48.91","I10.","E11.9","M54.2","F41.9","N39.0","R06.02","F25.1","I50.31","J96.11","E66.01","NO DATA","Z68.43","N95.0","N85.8","D64.9","R35.0","Z99.89","Z99.81","I50.33","I25.10","Z95.1","Z91.81","G62.9","N30.01","I13.0","I50.43","J96.10","E11.22","N18.2","M10.9","E87.6","I35.0","E78.5","M46.1","I50.41","I50.42","I25.708","I11.0","E78.2","J81.0","N93.9","N17.9","Z79.01","I48.20","N18.31","Z68.42","K21.9","J30.9","I50.30","I08.8"],"date":["2021-06-20","2020-12-26","2020-06-09","2021-01-28","2020-06-09","2021-07-12","2021-07-12","2021-07-12","2021-07-12","2020-04-20","2021-07-12","2020-04-20","2020-12-22","2021-06-03","2020-12-26","2020-12-26","2021-07-06","2020-12-26","2020-12-26","2021-07-09","2021-07-06","2021-07-06","2020-12-22","2020-07-27","2020-07-27","2020-12-24","2021-07-08","2020-12-23","2020-12-26","2021-07-12","2020-11-23","2020-12-22","2020-12-22","2020-12-22","2020-12-22","2020-12-22","2020-12-22","2020-12-22","2020-12-24","2020-12-22","2020-12-22","2020-12-22","2020-10-26","2020-10-26","2020-10-26","2020-10-26","2020-12-22","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-07-08","2020-12-22","2020-12-23","2020-12-23"],"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":""}]}]}