{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CECEILA NELSON","gend":1,"add":"PO BOX 733","city":"VERONA","state":"VA","zip":"24482-9998","dob":"1987-10-31","age":"","mstatus":"","insh":"1176632*01","cliId":"","pno":"540\/255-6927","cno":"","email":"","ename":"","eno":"","pphy":"REID, JAMES R MD","ppno":"540\/942-1200","pcpadd":"15 BOYINGTON BLVD SUITE A01","pcpcity":"WAYNESBORO","pcpstate":"VA","pcpzip":22980,"pcpcounty":"","pcpid":"","pcpname":"UNIVERSITY OF VIRGINIA PHYSICIANS GROUP","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/942-0151","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F32.9","F41.9","F15.10","F10.21","H57.12","J96.01","R94.31","G93.40","T44.3X2A","T45.0X2A","R40.20","R40.2432","Z87.892","E87.6","F10.10","Z91.5","Z88.6","R50.9","R42.","B34.9","R05.","F33.2","F33.41","T14.91XA","R06.89","T50.902A","Z98.890","R39.89","B00.1","N88.9","F33.9","T65.92XA","R41.82","V62.84","S61.512A","J69.0","F12.10","V58.69","Z91.14","T45.0X3A"],"date":["2020-05-04","2020-05-08","2020-05-08","2020-05-04","2019-05-11","2019-12-18","2019-12-18","2019-12-18","2019-12-18","2019-12-18","2019-12-18","2019-12-18","2019-12-19","2019-12-18","2020-05-08","2019-12-18","2019-12-18","2019-12-18","2020-04-29","2019-02-14","2019-12-21","2020-05-08","2020-02-07","2019-12-17","2019-12-17","2019-12-19","2019-12-19","2020-07-28","2020-07-28","2020-07-28","2019-11-06","2019-12-17","2019-12-17","2019-11-04","2019-11-03","2019-12-21","2019-11-04","2019-11-04","2019-11-04","2019-12-17"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}