{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" DEMHASIBLA","gend":0,"add":" NOSREFFEJ 518319014 TPA RD KRAP","city":"HERNDON","state":"VA","zip":"20171-9998","dob":"1980-12-23","age":"","mstatus":"","insh":"5142210*62","cliId":"","pno":"86\/1753289-5","cno":"","email":"","ename":"","eno":"","pphy":"VARMA, SOHAN R MD","ppno":"703\/436-9969","pcpadd":"4229 LAFAYETTE CENTER DR STE 1125B-","pcpcity":"CHANTILLY","pcpstate":"VA","pcpzip":20151,"pcpcounty":"","pcpid":"","pcpname":"WASHINGTON INTERNAL MEDICINE INC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.65","E11.69","E78.5","E04.1","I10.","E11.9","E55.9","R41.82","R07.9","Z74.3","B34.9","Z20.822","R06.02","Z71.2","E11.21","E02.","E66.9","F43.0","D72.819"],"date":["2021-10-19","2021-09-04","2022-05-20","2020-12-11","2022-05-20","2021-10-12","2022-04-01","2021-10-19","2021-10-19","2021-10-19","2021-10-12","2021-10-12","2021-10-12","2022-05-20","2022-05-20","2022-03-25","2022-05-13","2021-10-19","2022-01-21"],"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":[["","65862020290","LOSARTAN","TAB 50MG","90","Select","Select",""],["","00002771559","BASAGLAR","INJ 100UNIT","15","Select","Select",""],["","68382075810","METFORMIN","TAB 500MG","180","Select","Select",""],["","68382025116","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","08222710048","PEN  NEEDLES","MIS 31GX6MM","100","Select","Select",""],["","44946101802","OMEGA-3","CAP 1050MG","180","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","00591046010","GLIPIZIDE","TAB 5MG","60","Select","Select",""],["","53885065701","ONETOUCH","KIT VERIO","1","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","00093727198","PIOGLITAZONE","TAB 15MG","30","Select","Select",""],["","00006057761","JANUMET","TAB 50-1000","60","Select","Select",""],["","00597015230","JARDIANCE","TAB 10MG","30","Select","Select",""],["","68180051201","LISINOPRIL","TAB 2.5MG","30","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","15","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}