{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RACHEL   M ZIMMERMAN","gend":1,"add":"3205 SEWELLS POINT RD APT 9","city":"NORFOLK","state":"VA","zip":"23513-9998","dob":"1981-06-15","age":"","mstatus":"","insh":"4568737*01","cliId":"","pno":"757\/359-7632","cno":"757\/359-7632","email":"","ename":"","eno":"","pphy":"TUCKER, MICHAEL MD","ppno":"757\/625-3777","pcpadd":"110 KINGSLEY LANE SUITE 411","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23505,"pcpcounty":"","pcpid":110850,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","D50.9","R53.83","K91.1","I16.1","R51.","K27.9","E83.10","F17.210","Z80.41","Z72.0","I15.9","E83.19","E87.6","E53.8","E55.9","J45.909","R51.9","Z01.419","Z12.39","D50.8","Z98.84","K92.2","G25.9","N85.00","Z32.02","R69.","T14.90XA","Z00.00","N92.0","D51.3","E83.39","G47.30","Z87.442","N93.9","G43.909","G47.33","K21.9","I16.0","E83.119","D64.9","R68.83","Z20.828"],"date":["2021-07-09","2021-06-04","2020-01-23","2020-07-01","2020-07-17","2020-09-04","2020-07-17","2020-07-14","2020-07-14","2021-05-27","2020-07-15","2020-07-14","2020-07-14","2020-07-17","2020-07-17","2020-07-17","2020-08-12","2021-03-25","2021-01-07","2021-01-07","2020-07-15","2020-07-15","2020-07-15","2021-03-05","2021-06-18","2021-06-18","2020-06-16","2020-06-16","2020-06-04","2021-01-13","2020-07-14","2020-07-14","2020-07-15","2020-07-14","2021-03-15","2020-03-05","2020-03-05","2020-09-04","2020-07-15","2020-07-15","2020-07-15","2021-03-25","2021-03-25"],"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":""}]}]}