{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MIR A ALI","gend":0,"add":"921 Holly Creek Dr","city":"Great Falls ","state":"VA","zip":"22066-1214","dob":"1942-01-01","age":"","mstatus":"","insh":11010388,"cliId":"3MX1EQ4AY16","pno":7037661547,"cno":7037661547,"email":"","ename":"","eno":"","pphy":"IYER, RAVI R","ppno":7034045900,"pcpadd":"13505 DULLES TECHNOLOGY DR, SUITE A ","pcpcity":"HERNDON ","pcpstate":"VA","pcpzip":201713401,"pcpcounty":"","pcpid":"P9463976","pcpname":"LOUDOUN MEDICAL GROUP","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"N","ano":"","add2":"","add3":"","madd1":"921 Holly Creek Dr","madd2":"","madd3":"","mcity":"Great Falls ","mstate":"VA","mzip":"22066-1214","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["I10","M17.12","C91.90","Z12.5","Z00.00","E55.9","C91.10","R73.02","K59.09","K08.409","Z87.891","Z97.2","Z68.21","E78.49","H93.19","H90.6"],"date":["2021-08-05","2020-11-10","2020-06-09","2020-11-02","2020-11-02","2020-11-10","2020-11-06","2020-11-10","2020-06-08","2020-06-08","2020-06-08","2020-06-08","2020-06-08","2021-08-05","2021-08-05","2021-09-17"],"priorHcc":["","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"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":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","68180098103","LISINOPRIL","TAB 20MG","","Select","Select",""],["","378875006","DICLOFENAC","GEL 0.01","","Select","Select",""],["","65862021901","CEFDINIR","SUS 250\/5ML","","Select","Select",""],["","16729013716","CLONAZEPAM","TAB 1MG","","Select","Select",""],["","68382013201","TAMSULOSIN","CAP 0.4MG","","Select","Select",""],["","781808926","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","49281012065","FLUZONE HD","INJ PF 20-21","","Select","Select",""],["","65862021901","CEFDINIR ","SUS 250\/5ML","100","Select","Select",""],["","68180098103","LISINOPRIL ","TAB 20MG","90","Select","Select",""],["","378875006","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","68382013201","TAMSULOSIN ","CAP 0.4MG","90","Select","Select",""],["","16729013716","CLONAZEPAM ","TAB 1MG","5","Select","Select",""],["","65862064169","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","49281012065","FLUZONE ","PF 20-21","0.7","Select","Select",""],["","68382056401","METOPROL","25MG ER","90","Select","Select",""],["","49281012065","FLUZONE","PF 20-21","0.7","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}