{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"W D ECNERWALIII SMAILLI","gend":0,"add":"          DAOR YENAT 5029                         ","city":"MANASSAS                 ","state":"VA","zip":"20110-9998","dob":"1990-10-30","age":"","mstatus":"","insh":"10112162","cliId":"","pno":"7517518205","cno":"","email":"","ename":"","eno":"","pphy":"FAROOQI, SHAZIA H","ppno":8008981960,"pcpadd":"9274 CORPORATE CIR,STE 100","pcpcity":"Manassas","pcpstate":"VA","pcpzip":201104153,"pcpcounty":"","pcpid":"","pcpname":"STARTING POINT OF VIRGINIA PC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"9205 TANEY ROAD                                   ","madd2":"                                                  ","madd3":"","mcity":"MANASSAS                 ","mstate":"VA","mzip":"20110-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K21.9","Z76.0","G40.209","G93.49","Q99.8","G40.919","R32","L22","R39.81","F84.0","F79","Z99.3","I10","E11.9","E55.9","E78.5","J20.9","R05","Z00.00","Z13.0","Z13.29","R26.89","M62.81","R06.02","Z86.19","E11.65","J30.9","H93.299","R09.81","Z01.818","R31.9","R45.1","R60.9","G40.219","G40.909","Z71.3","Z79.4","H66.009","L85.3","L73.0","L21.9","L73.8","Z23","R53.83","F23","N39.0","R10.9","R35.0","G40.319","Z02.89","R29.898","U09.9","Z13.1","Z13.220","K02.9","Z79.84","Z79.899","R60.0","M79.89"," ","R56.9","G40.419"],"date":["2022-01-18","2022-11-02","2022-01-24","2022-01-24","2022-01-24","2022-04-18","2022-08-12","2022-08-12","2022-08-12","2022-11-15","2022-08-12","2022-08-12","2022-11-02","2022-11-02","2022-09-19","2022-11-02","2020-06-09","2020-04-15","2022-07-28","2022-07-28","2022-07-28","2022-10-06","2021-12-03","2022-10-06","2021-12-03","2022-10-10","2021-08-17","2021-07-08","2021-07-08","2021-07-24","2020-07-27","2020-12-07","2022-11-02","2021-08-30","2021-08-30","2020-10-13","2022-08-12","2020-09-26","2021-10-04","2021-10-04","2021-10-04","2021-10-04","2020-10-10","2022-10-06","2022-11-02","2021-11-20","2022-07-28","2022-03-18","2022-04-18","2022-04-27","2022-10-06","2022-10-06","2022-07-28","2022-07-28","2022-08-12","2022-08-12","2022-08-12","2022-10-28","2022-08-30","2022-11-28","2022-10-28","2022-11-28"],"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":[["","68462019005","NAPROXEN","TAB 500MG","60","Select","Select",""],["","63304069201","CLINDAMYCIN","CAP 150MG","90","Select","Select",""],["","00228207710","TEMAZEPAM","CAP 30MG","30","Select","Select",""],["","33342008307","OLANZAPINE","TAB 5MG ODT","30","Select","Select",""],["","69315011610","FUROSEMIDE","TAB 20MG","90","Select","Select",""],["","65702040810","ACCU-CHEK","TES AVIVA PL","500","Select","Select",""],["","55111025960","ZIPRASIDONE","CAP 80MG","60","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","75","Select","Select",""],["","65162075710","DIVALPROEX","TAB 500MG ER","60","Select","Select",""],["","00536110301","ALCOHOL","PAD 0.7","100","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","90","Select","Select",""],["","16729000517","SIMVASTATIN","TAB 20MG","90","Select","Select",""],["","45963070996","METOPROL","TAB 25MG ER","30","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","15","Select","Select",""],["","52565008230","CLOBETASOL","GEL 0.0005","30","Select","Select",""],["","72578003601","METFORMIN","TAB 750MG ER","180","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","57237016250","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","55111028050","LEVOFLOXACIN","TAB 500MG","10","Select","Select",""],["","65862050301","AMOX\/K","TAB 875-125","14","Select","Select",""],["","33342033354","TRIAMCINOLON","OIN 0.001","454","Select","Select",""],["","08290320109","BD  PEN NEEDL","MIS 31GX8MM","300","Select","Select",""],["","45802041954","AMMONIUM","LOT 0.12","225","Select","Select",""],["","43547040610","CLONAZEPAM","TAB 0.5MG","10","Select","Select",""],["","45802046564","KETOCONAZOLE","SHA 0.02","120","Select","Select",""],["","23155000101","HYDRALAZINE","TAB 10MG","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":["",""]}},{"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":""}]}]}