{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EDNEM M ANASERAVILO Z","gend":1,"add":" 8121# TEERTS SDAE S 1021                         ","city":"ARLINGTON                ","state":"VA","zip":"22202-9998","dob":"1955-02-01","age":"","mstatus":"","insh":"10118984","cliId":"","pno":"5230706884","cno":"","email":"","ename":"","eno":"","pphy":"VIYUOH, ADELINE CHIA","ppno":7036837220,"pcpadd":"325 S WASHINGTON ST,STE A","pcpcity":"Alexandria","pcpstate":"VA","pcpzip":223143627,"pcpcounty":"","pcpid":"","pcpname":"INOVA INTERNAL MEDICINE OLD TOWN","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"1201 S EADS STREET #1218                          ","madd2":"                                                  ","madd3":"","mcity":"ARLINGTON                ","mstate":"VA","mzip":"22202-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J45.30","R06.00","R05.8","M31.30","K28.7","D64.9","Z79.899","R05.9","J31.0","J30.9","J45.909","K29.70","U07.1","R91.8","R05.1","R05","T80.90XA","Z01.818","R68.83","R07.0","T80.89XA","Z20.828","Z03.818","R00.2","J18.9","Z86.16","I10","Z12.11","Z12.12","K43.2","K21.9","Z86.79","K59.00","M25.562","M25.512","G89.29","M17.12","M19.012","R51.9","R09.82","K52.89","R10.31","D50.9","K64.4","K63.89","K63.3","K64.0","K64.9","D25.9","K57.30","K52.9","K43.9","B34.9","J32.9","K57.32","K64.8","D50.8","K62.1","Z98.0","Z90.49","Z86.010","Z79.52","E05.00","T80.90XD"," "],"date":["2022-01-25","2022-01-25","2022-01-11","2022-11-17","2022-01-13","2022-01-13","2022-11-17","2022-02-10","2022-01-20","2022-01-20","2022-01-20","2022-01-25","2022-01-20","2022-01-20","2022-01-25","2021-06-04","2022-01-31","2022-01-31","2022-01-31","2022-01-31","2022-01-31","2021-04-14","2021-04-14","2021-06-04","2021-06-11","2021-11-08","2022-02-25","2022-08-16","2021-06-07","2021-06-11","2022-07-06","2020-09-17","2021-11-08","2020-10-16","2020-10-16","2020-10-16","2020-10-16","2020-10-16","2021-10-18","2021-10-18","2021-11-08","2021-11-08","2021-11-08","2021-11-08","2021-12-03","2021-11-08","2022-08-16","2021-11-08","2021-12-03","2022-08-16","2021-12-03","2021-12-03","2020-12-28","2021-12-28","2022-08-16","2022-08-16","2022-08-16","2022-08-16","2022-08-16","2022-08-16","2022-08-16","2022-08-16","2022-09-12","2022-09-12","2022-11-17"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"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":[["","64380076921","PEG-3350\/KCL","SOL \/SODIUM","4,000.00","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","20","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","90.00","Select","Select",""],["","55111012705","CIPROFLOXACN","TAB 500MG","20","Select","Select",""],["","51991081403","AZELASTINE","SPR 0.001","30","Select","Select",""],["","00173069600","ADVAIR","AER 250\/50","60","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00093227534","AMOX\/K","TAB 875-125","20","Select","Select",""],["","00378932132","WIXELA","AER 250\/50","60","Select","Select",""],["","00143178701","BUT\/APAP\/CAF","TAB ","20","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","60","Select","Select",""],["","00093317431","ALBUTEROL","FAT E","8.5","Select","Select",""],["","61442017230","CEFACLOR","CAP 500MG","20","Select","Select",""],["","68462056417","MUPIROCIN","CRE 0.02","30","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","30","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":""}]}]}