{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" SUODRIFZIAVREP","gend":1,"add":"lihcriaF 6117302 tpA rD d","city":"Alexandria               ","state":"VA","zip":"22306-7195","dob":"1952-01-30","age":"","mstatus":"","insh":"10112813","cliId":"","pno":"0430776069","cno":"","email":"","ename":"","eno":"","pphy":"ALAMO, INES","ppno":7037999500,"pcpadd":"8109 TIS WELL DR STE 511,STE 511","pcpcity":"Alexandria","pcpstate":"VA","pcpzip":22306,"pcpcounty":"","pcpid":"","pcpname":"INOVA PRIMARY CARE MOUNT VERNON","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"7116 Fairchild Dr Apt 203","madd2":"","madd3":"","mcity":"Alexandria               ","mstate":"VA","mzip":"22306-7195","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["ASIAN\/PACIFIC"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E78.2","R53.82","I10","E11.9","M81.0","M19.90","R51.9","M51.36","Z00.00","H61.23","M25.561","E11.36","M25.562","J30.9","G89.29","Z79.84","R10.9","R93.2","R26.2","R26.81","R68.84","R20.0","G31.9","G93.89","M17.0","E55.9","R21","M85.859","M70.71","D17.1","R05.3","K12.0","R07.9","E78.00","Z11.59","G47.00","Z12.11","Z12.31","I11.9","G45.9","Z79.82","E78.5","Z20.828","L20.84","L21.8","L29.8","L30.4","E66.01","Z68.41","H81.10","H40.1131","J06.9","R68.89","D64.9","H04.123","H25.13","H52.13","E11.59","G43.909","K21.9","F41.1","J45.909","M51.26","M51.37","M47.816","E11.65","M16.0","H04.129","E66.8","Z68.36","Z78.9","K59.09","M15.9","M47.9","E11.39","H40.9","H52.4","L29.9","M79.671","F41.9","M79.672","R29.898","H61.22","K80.20","I83.813","M54.50","M25.551","H04.121","H40.023"],"date":["2021-11-29","2021-04-12","2022-10-03","2022-04-05","2022-10-31","2022-10-31","2022-08-08","2022-10-03","2022-10-03","2022-10-03","2022-10-13","2022-10-03","2022-10-13","2022-11-14","2022-10-03","2022-10-03","2021-10-11","2021-10-11","2022-07-11","2022-07-11","2022-04-18","2020-12-11","2020-12-11","2020-12-11","2022-10-13","2022-07-18","2021-12-20","2021-11-02","2021-10-08","2021-10-25","2022-11-14","2020-05-15","2022-08-08","2020-09-10","2020-09-10","2022-11-14","2021-01-25","2021-01-25","2021-07-21","2020-11-09","2020-11-09","2020-11-09","2020-11-09","2022-06-21","2022-06-21","2022-06-21","2022-06-21","2022-04-05","2021-09-09","2021-06-23","2021-12-13","2022-01-10","2022-02-01","2022-02-01","2020-10-02","2021-12-13","2021-12-13","2021-07-21","2021-07-21","2022-01-10","2021-07-21","2021-07-21","2021-10-08","2021-10-08","2021-10-08","2021-11-04","2021-10-08","2020-08-06","2020-08-06","2020-08-06","2020-12-16","2020-08-06","2020-08-06","2020-08-06","2020-08-06","2020-08-06","2020-08-06","2020-08-19","2020-08-19","2020-08-19","2020-08-19","2020-11-13","2021-11-22","2021-10-11","2022-07-18","2021-11-17","2021-11-17","2021-04-02","2021-04-02"],"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":[]},{"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":[["","65162019050","NAPROXEN","TAB 500MG","40","Select","Select",""],["","49281072010","FLUBLOK QUAD","INJ 2020-21","0.5","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","68382075810","METFORMIN","TAB 500MG","180","Select","Select",""],["","00023320503","LUMIGAN","SOL 0.0001","7.5","Select","Select",""],["","13668000805","ZOLPIDEM","TAB 10MG","30","Select","Select",""],["","64980051401","TIMOLOL MAL","SOL 0.5% OP","10","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","00023916360","RESTASIS","EMU 0.0005","180","Select","Select",""],["","31722070190","LOSARTAN POT","TAB 50MG","135","Select","Select",""],["","69238115409","EZETIMIBE","TAB 10MG","90","Select","Select",""],["","00228202950","ALPRAZOLAM","TAB 0.5MG","20","Select","Select",""],["","10702025350","BUT\/APAP\/CAF","TAB ","20","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8.5","Select","Select",""],["","23155000810","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","10","Select","Select",""],["","45802025742","MOMETASONE","CRE 0.001","45","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","90","Select","Select",""],["","80777028299","MODERNA BIVA","INJ BA4\/BA5","0.5","Select","Select",""],["","31722057230","ESOMEPRA MAG","CAP 20MG DR","90","Select","Select",""],["","70377000612","ROSUVASTATIN","TAB 5MG","90","Select","Select",""],["","00193731221","CONTOUR","TES NEXT","100","Select","Select",""],["","51672126705","TRIAMCINOLON","PST DEN 0.1%","5","Select","Select",""],["","70461012003","FLUAD QUADRI","INJ 0.5ML","0.5","Select","Select",""],["","68462053253","CLOBETASOL","SOL 0.0005","50","Select","Select",""],["","45802046564","KETOCONAZOLE","SHA 0.02","120","Select","Select",""],["","49281012265","FLUZONE HD","INJ 2022-23","0.7","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","48","Select","Select",""],["","59746012106","MECLIZINE","TAB 25MG","90","Select","Select",""],["","00000000000","SUCRALFATE","SUS 1GM\/10ML","600","Select","Select",""],["","65862032904","ALENDRONATE","TAB 70MG","12","Select","Select",""],["","63304069205","CLINDAMYCIN","CAP 150MG","21","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":["",""],"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":""}]}]}