{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LAYLA MULLASI","gend":1,"add":"3939 LINCOLNSHIRE ST ","city":"ANNANDALE","state":"VA","zip":"22003-9998","dob":"1952-01-01","age":"","mstatus":"","insh":11010389,"cliId":"9QR3UG4EQ84","pno":5712374574,"cno":5712374574,"email":"","ename":"","eno":"","pphy":"CHADHA, VIJAY K","ppno":7034780325,"pcpadd":"1800 Town Center Dr Ste 214","pcpcity":"Reston","pcpstate":"VA","pcpzip":201903238,"pcpcounty":"","pcpid":"P0130335","pcpname":"LOUDOUN MEDICAL GROUP","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"3939 LINCOLNSHIRE ST ","madd2":"","madd3":"","mcity":"ANNANDALE","mstate":"VA","mzip":"22003-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["I10","E11.9","Z79.4","E78.00","M54.5","R32","F41.9","M47.816","M47.817","M51.37","M43.17","M16.12","H40.033","H40.1131","T15.11XA","H04.123","R39.15","Z20.828","M18.11","E78.5","E66.9","Z79.82","Z68.31","E87.5","E11.3513","E11.3593","H43.821","H25.12","Z00.00","Z12.11","R71.8"],"date":["2021-11-15","2021-11-15","2021-11-15","2021-11-15","2020-11-09","2021-06-14","2020-11-09","2020-11-09","2020-11-09","2020-11-09","2020-11-09","2020-11-09","2020-11-12","2021-09-17","2020-11-12","2020-11-19","2020-12-03","2021-02-06","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2021-03-23","2021-06-02","2021-09-17","2021-09-17","2021-09-17","2021-11-08","2021-11-08","2021-11-15"],"priorHcc":[null,null,null,null,"","","","","","","","","","","","","","","","","","","","","","","","",null,null,null]}},{"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":[["","60505014201","GLIPIZIDE","TAB 10MG","","Select","Select",""],["","56151014701","TRUPLUS LANC","MIS 33G","","Select","Select",""],["","67877019805","AMLODIPINE","TAB 5MG","","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","","Select","Select",""],["","59762033302","LATANOPROST","SOL 0.00005","","Select","Select",""],["","193731221","CONTOUR","TES NEXT","","Select","Select",""],["","88221905","LANTUS SOLOS","INJ 100\/ML","","Select","Select",""],["","23155010401","METFORMIN","TAB 1000MG","","Select","Select",""],["","193781801","CONTOUR NEXT","KIT ONE","","Select","Select",""],["","16714087601","ATORVASTATIN","TAB 40MG","","Select","Select",""],["","31722070230","LOSARTAN POT","TAB 100MG","","Select","Select",""],["","70069023101","BRIMONIDINE","SOL 0.2% OP","","Select","Select",""],["","193658621","MICROLET","MIS LANCETS","","Select","Select",""],["","67877019805","AMLODIPINE ","TAB 5MG","90","Select","Select",""],["","56151014701","TRUPLUS ","MIS 33G","200","Select","Select",""],["","60505014201","GLIPIZIDE ","TAB 10MG","180","Select","Select",""],["","31722070290","LOSARTAN ","TAB 100MG","90","Select","Select",""],["","53885027210","ONETOUCH ","TES VERIO","200","Select","Select",""],["","23155010401","METFORMIN ","TAB 1000MG","180","Select","Select",""],["","70069023101","BRIMONIDINE ","SOL 0.2% OP","5","Select","Select",""],["","59762033302","LATANOPROST ","SOL 0.00005","7.5","Select","Select",""],["","88221905","LANTUS ","INJ 100\/ML","30","Select","Select",""],["","193727870","CONTOUR ","TES NEXT","200","Select","Select",""],["","193658621","MICROLET ","MIS LANCETS","200","Select","Select",""],["","16714087601","ATORVASTATIN ","TAB 40MG","90","Select","Select",""],["","00169643810","LEVEMIR ","FLEXTOUC","30","Select","Select",""],["","56151014701","TRUPLUS","33G","200","Select","Select",""],["","31722070290","LOSARTAN","100MG","90","Select","Select",""],["","00169643810","LEVEMIR","FLEXTOUC","30","Select","Select",""],["","00088221905","LANTUS","100\/ML","30","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","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":""}]}]}