{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHANIQUA JONES","gend":1,"add":"633 ROSEMARY LN","city":"DANVILLE","state":"VA","zip":"24541-9998","dob":"1992-12-16","age":"","mstatus":"","insh":"2129058*01","cliId":"","pno":"804\/720-7675","cno":"804\/720-7675","email":"","ename":"","eno":"","pphy":"PENDYAL, KAUSALYA MD","ppno":"804\/560-0490","pcpadd":"SUITE 4 681 HIOAKS ROAD","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23225,"pcpcounty":"","pcpid":149263,"pcpname":"Primary Health Group - Chippenham","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/560-3424","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F44.7","J45.40","G43.709","D50.9","F41.8","Z30.09","Z68.30","Z13.29","Z11.4","Z00.00","J45.901","R07.9","R45.7","R20.2","E66.9","F41.9","R53.1","Z20.828","R07.89","M62.81","G83.14","G83.24","Z20.822","F44.6","I69.354","F41.1","F33.1","I63.9","J06.9","N39.0","I10.","J45.909","Z91.013","Z86.73","J02.9","R50.9"],"date":["2020-07-02","2020-03-26","2020-03-26","2020-03-26","2020-03-26","2020-03-26","2020-03-26","2020-03-26","2020-03-26","2020-03-26","2020-07-02","2020-07-02","2020-07-02","2020-07-03","2020-07-03","2020-07-03","2020-07-03","2021-06-11","2021-09-13","2020-07-02","2020-07-02","2020-07-02","2021-09-13","2020-07-03","2020-07-03","2020-07-03","2020-07-03","2020-07-03","2021-09-13","2021-09-13","2021-09-13","2021-09-13","2021-09-13","2021-09-13","2021-09-13","2021-09-13"],"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","",""],["N\/A","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":""}]}]}