{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ITUG R ALIRODSAGRAV ZERRE","gend":1,"add":"ETSA 79984TEERTS LL","city":"CHANTILLY                ","state":"VA","zip":"20152-9998","dob":"1946-10-03","age":"","mstatus":"","insh":"10110446","cliId":"","pno":"0317515886","cno":7039815601,"email":"","ename":"","eno":"","pphy":"ELSAYED, SOHAIB S","ppno":8667753551,"pcpadd":"25055 RIDING PLZ STE 220,STE 220","pcpcity":"South Riding","pcpstate":"VA","pcpzip":201525920,"pcpcounty":"","pcpid":"","pcpname":"NOVANT HEALTH LAKE MANASSAS OBGYN","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"N","ano":"","add2":"                                                  ","add3":"","madd1":"48997 ASTELL STREET","madd2":"                                                  ","madd3":"","mcity":"CHANTILLY                ","mstate":"VA","mzip":"20152-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z00.00","R74.8","Z12.31","Z01.818","Z20.822","M81.0","E78.00","M54.12","M54.16","H25.13","H15.002","H40.013","R74.01","R74.02","K80.21","R73.03","E55.9","Z12.11","D12.5","K57.30","J45.909","Z86.718","Z79.82","I82.409","Z13.31","K80.20","R10.13","R11.2","Z01.810","Z23","H04.123","H01.009","H10.45","L03.213","K76.89","K82.9","Z68.22","M85.852","M85.851","R10.816","K80.70","K74.3","H47.233","H43.813","H35.3131","H52.7","E78.5"],"date":["2021-01-15","2021-06-03","2021-04-01","2021-05-03","2021-10-16","2021-03-31","2021-08-16","2021-02-25","2021-02-25","2021-07-19","2021-03-17","2021-03-17","2021-03-20","2021-03-20","2021-03-31","2021-07-05","2021-07-05","2021-08-16","2021-08-16","2021-08-16","2021-08-16","2021-08-16","2021-08-16","2021-02-06","2021-02-06","2021-05-06","2021-03-16","2021-03-16","2021-07-05","2021-01-15","2021-07-19","2021-02-24","2021-02-24","2021-03-03","2021-03-16","2021-04-22","2021-04-22","2021-02-19","2021-02-19","2021-03-16","2021-03-16","2021-03-31","2021-07-19","2021-05-19","2021-07-19","2021-05-19","2021-04-06"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"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":{"comment":"","sub":[["","60505057501","OLOPATADINE","DRO 0.001","5","Select","Select",""],["","65862032904","ALENDRONATE","TAB 70MG","12","Select","Select",""],["","49281012065","FLUZONE","INJ PF 20-21","0.7","Select","Select",""],["","68382025016","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","70461012103","FLUAD","INJ 2021-22","0.5","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","8","Select","Select",""]]}},{"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":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"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":""}]}]}