{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ELLEN   L ALLEN","gend":1,"add":"1115 VIRGINIA AVE LOT 1","city":"HARRISONBURG","state":"VA","zip":"22802-9998","dob":"1985-05-16","age":"","mstatus":"","insh":"7816243*01","cliId":"","pno":"540\/478-3975","cno":"540\/478-3975","email":"","ename":"","eno":"","pphy":"JOYCE, RICHARD A MD","ppno":"434\/286-6434","pcpadd":"295 EAST MAIN STREET","pcpcity":"SCOTTSVILLE","pcpstate":"VA","pcpzip":24590,"pcpcounty":"","pcpid":117378,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"WESTERN\/ CHARLOTTESVILLE","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":["Z36.3","O99.212","O99.350","G40.909","Z34.82","E66.01","R93.9","O09.522","Z3A.20","G40.109","Z3A.19","Z34.90","O47.03","Z3A.37","Z20.828","K76.0","R10.84","R10.13","K92.0","D62.","B96.81","K29.50","K25.3","R52.","O47.9","S02.2XXA","O21.9","R05.","Z3A.17","Z3A.18","O99.824","Z37.0","O99.354","Z3A.38","Z79.899","Z28.09","Z87.891","Z85.41","Z86.69","Z87.09","Z88.6","Z80.3","Z82.49","Z82.61","R10.11","D64.9","K21.9","R53.1","F19.10","K92.2","O80.","F33.1","Z11.59","R10.9","R11.10","F32.9","O9A.211","S09.90XA","Z3A.01","R11.2","Z20.822","R11.15"],"date":["2020-02-17","2020-02-17","2020-02-17","2021-07-04","2020-02-17","2020-02-17","2020-02-17","2020-02-17","2020-02-17","2020-02-17","2020-02-17","2020-07-21","2020-06-16","2020-06-16","2021-02-05","2021-04-28","2021-06-22","2021-07-05","2021-07-05","2021-07-05","2021-07-05","2021-07-05","2021-07-05","2020-06-16","2020-06-21","2020-08-21","2020-01-23","2020-01-23","2020-01-23","2020-01-27","2020-06-21","2020-06-21","2020-06-21","2020-06-21","2020-06-21","2020-06-21","2020-06-21","2020-06-21","2020-06-21","2020-06-21","2020-06-21","2020-06-21","2020-06-21","2020-06-21","2021-06-30","2021-07-04","2021-07-04","2021-07-04","2021-07-04","2021-07-06","2020-06-21","2020-08-17","2020-09-01","2021-06-21","2021-06-21","2021-07-04","2020-02-03","2020-02-03","2020-02-03","2021-06-25","2021-06-25","2021-06-30"],"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":""}]}]}