{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" KEREDYELIW","gend":0,"add":"INU 341DAOR YT","city":"KENBRIDGE","state":"VA","zip":"23944-3902","dob":"1966-02-07","age":"","mstatus":"","insh":"51019767","cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"GOVIL, KANIKA","ppno":7039566757,"pcpadd":"14133 Robert Paris Ct, ","pcpcity":"CHANTILLY","pcpstate":"VA","pcpzip":201514203,"pcpcounty":"","pcpid":"","pcpname":"CHANTILLY FAMILY MEDICINE LLC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"REFLECTIONS ALF","add3":"","madd1":"143 UNITY ROAD","madd2":"REFLECTIONS ALF","madd3":"","mcity":"KENBRIDGE","mstate":"VA","mzip":"23944-3902","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D50.9","I11.9","N18.3","N29","C90.00","R80.9","J44.9","E03.9","G61.0","B35.1","M20.10","L85.1","N17.9","N18.30","I12.9","E87.5","U07.1","D51.9","Z11.1","I10","R41.3","Z23","J44.1","F32.9","F31.81","F41.1","Z12.5","Z00.00","Z68.27","Z82.49","F03.91","F33.0","E11.3593","E11.3591","H33.41","H43.11","L60.0","B35.3"],"date":["2020-10-07","2020-07-30","2020-03-20","2020-11-20","2020-11-20","2021-05-21","2021-09-01","2021-09-02","2020-10-24","2020-10-24","2020-10-24","2020-10-24","2020-11-20","2021-05-21","2021-05-21","2021-05-21","2022-02-02","2021-09-02","2021-07-07","2021-09-02","2022-03-17","2021-11-29","2022-02-02","2022-03-17","2019-02-13","2019-03-25","2019-03-25","2019-03-25","2019-03-22","2019-03-25","2019-03-25","2019-03-25","2019-07-29","2019-04-05","2019-09-10","2019-07-29","2019-06-12","2019-06-12"],"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":{"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":[["","68180072103","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","65862001205","SERTRALINE","TAB 50MG","30","Select","Select",""],["","69315012710","FOLIC","TAB 1000MCG","30","Select","Select",""],["","68180051703","LISINOPRIL","TAB 40MG","30","Select","Select",""],["","00172208380","HYDROCHLOROT","TAB 25MG","31","Select","Select",""],["","46122008402","GNP","TAB 65MG","62","Select","Select",""],["","87701040729","VITAMIN","TAB 100MG","30","Select","Select",""],["","00904053060","TAB-A-VITE","TAB ","30","Select","Select",""],["","11845005651","B-1","TAB 100MG","31","Select","Select",""],["","13668010290","DONEPEZIL","TAB 5MG","27","Select","Select",""],["","80681002000","MULTIVITAMIN","TAB ","31","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","60","Select","Select",""],["","45802043411","CLOTRIMAZOLE","CRE 0.01","60","Select","Select",""],["","79854040055","MULTIVIT-MINERALS","RAL S TABLET","31","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0.3","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":""}]}]}