{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   DAMMAHUMYRHDUAHC A","gend":0,"add":"Q 28031NL EDAU","city":"DALE CITY","state":"VA","zip":"22193-9998","dob":"1927-02-08","age":"","mstatus":"","insh":"35000910*327","cliId":"","pno":"59\/3079464-3","cno":"703\/953-4649","email":"","ename":"","eno":"","pphy":"HEYDARIAN, SIAMAK MD","ppno":"703\/497-6700","pcpadd":"2200 OPITZ BLVD STE 350","pcpcity":"WOODBRIDGE","pcpstate":"VA","pcpzip":22191,"pcpcounty":"","pcpid":"","pcpname":"ADULT PRIMARY CARE CENTER","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":" ","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G30.8","M62.84","H54.3","H54.42A4","I10.","I25.10","E11.65","K59.01","G47.09"],"date":["2022-11-03","2022-06-21","2022-06-21","2022-06-21","2022-06-15","2022-06-15","2022-06-15","2022-06-15","2022-11-03"],"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":[["","68180096501","LEVOTHYROXINE SODIUM","TAB 25MCG","90","Select","Select",""],["","57237001405","TAMSULOSIN HYDROCHLORIDE","CAP 0.4MG","60","Select","Select",""],["","00003089421","ELIQUIS","TAB 5MG","180","Select","Select",""],["","50111045001","TRAZODONE HYDROCHLORIDE","TAB 150MG","90","Select","Select",""],["","56151146304","TRUE METRIX SELF MONITORING BLOOD GLUCOSE STRIPS","TES GLUCOSE","-100","Select","Select",""],["","70377000812","ROSUVASTATIN CALCIUM","TAB 20MG","90","Select","Select",""],["","00185067401","HYDROXYZINE PAMOATE","CAP 25MG","30","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","50458057830","XARELTO","TAB 15MG","-30","Select","Select",""],["","55111046805","METOPROLOL SUCCINATE ER","TAB 100MG ER","30","Select","Select",""],["","00597015290","JARDIANCE","TAB 10MG","90","Select","Select",""],["","65862020230","LOSARTAN POTASSIUM","TAB 50MG","90","Select","Select",""],["","51079030630","POLYETHYLENE GLYCOL 3350","POW 3350 NF","30","Select","Select",""],["","08214035721","CAREONE LANCET SUPER THIN\/30G","MIS 30G","100","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":""}]}]}