{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"G P REMODRJ AICRA","gend":0,"add":"        DR ELLIVNAD 61641                         ","city":"WOODBRIDGE               ","state":"VA","zip":"22193-9998","dob":"1953-04-20","age":"","mstatus":"","insh":"10111038","cliId":"","pno":"2217506630","cno":"","email":"","ename":"","eno":"","pphy":"BORNACELLY PEREZ, MICHEL","ppno":7034946111,"pcpadd":"12480 DILLINGHAM SQ,","pcpcity":"Woodbridge","pcpstate":"VA","pcpzip":221925258,"pcpcounty":"","pcpid":"","pcpname":"INOVA MEDICAL GROUP LAKERIDGE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"14616 DANVILLE RD                                 ","madd2":"                                                  ","madd3":"","mcity":"WOODBRIDGE               ","mstate":"VA","mzip":"22193-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","E78.5","E11.69","E11.8","Z23","E11.65","H90.3","H93.13","R42","R11.2","H54.62","Z87.891","Z79.84","Z00.00","Z12.11","H81.10","E78.49","R11.10"," ","R73.9"],"date":["2022-04-17","2022-09-23","2021-09-10","2022-03-24","2021-11-05","2022-09-23","2022-05-16","2022-05-16","2022-04-17","2022-04-17","2022-04-17","2022-04-17","2022-04-17","2022-03-24","2022-03-24","2022-05-16","2021-09-03","2022-04-17","2022-09-23","2022-09-23"],"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":[["","53885027150","ONETOUCH","TES VERIO","100","Select","Select",""],["","16571066101","MECLIZINE","TAB 25MG","30","Select","Select",""],["","70377000315","SIMVASTATIN","TAB 20MG","90","Select","Select",""],["","67877056310","METFORMIN","TAB 1000MG","180","Select","Select",""],["","64980028001","GLIPIZIDE","TAB 5MG","90","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["1",""],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","",""],[""],[""],[""],[""]],"comment":[["","",""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}