{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HENRYK ZYWALEWSKI","gend":0,"add":"1429 NORTHGATE  SQUARE APT 22 ","city":"RESTON","state":"VA","zip":"20190-9998","dob":"1939-07-15","age":"","mstatus":"","insh":11010401,"cliId":"9AJ4HT2RN66","pno":2022515400,"cno":5713869603,"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":"11122 LAKESPRAY WAY  ","madd2":"","madd3":"","mcity":"RESTON","mstate":"VA","mzip":"20191-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["Z95.0","I10","E78.00","R01.1","G47.30","M16.11","M25.561","M17.11","M79.9","A41.9","N45.3","W18.30XA","Y93.89","Y92.89","Y99.8","I50.33","Z20.828","F05","M62.82","I24.8","E83.42","E87.6","F41.9","I11.0","I48.0","I48.91","R94.31","N43.3","I86.1","N43.41","N39.0","R53.1","N45.1","S09.8XXA","I67.2","S29.8XXA","R91.8","R26.9","Z78.9","I50.9","L02.91","Z00.00","R29.6","N50.9","Z71.89","M13.80","M62.81","I50.23","Z91.81","Z79.2","M12.9","I48.92","N17.9","J32.2","N49.2","N45.4","R35.0","N39.41","I49.5","I50.30","J98.4","I51.7","R69","J06.9","Z20.822","I50.32","I25.10","Z79.82","Z74.3","H25.13","H35.033","H35.3131","M17.0","R26.89","K59.01","W19.XXXS","R61","H54.7","R06.02"],"date":["2021-09-24","2021-09-02","2020-03-19","2020-03-19","2020-03-19","2020-03-19","2020-03-19","2020-03-19","2020-03-19","2021-01-20","2021-01-16","2020-12-05","2020-12-05","2020-12-05","2020-12-05","2020-12-16","2020-12-05","2020-12-05","2020-12-05","2020-12-05","2020-12-05","2020-12-16","2020-12-05","2021-09-24","2021-06-18","2021-09-24","2021-06-18","2020-12-12","2020-12-05","2020-12-05","2020-12-05","2021-06-19","2020-12-09","2020-12-05","2021-06-18","2020-12-05","2021-06-18","2021-09-23","2020-12-09","2020-12-09","2020-12-12","2021-01-04","2021-01-04","2021-01-04","2021-01-04","2021-10-29","2021-01-16","2021-01-16","2021-01-16","2021-01-16","2021-06-04","2020-12-08","2020-12-16","2020-12-08","2020-12-09","2020-12-15","2021-09-24","2021-09-02","2021-09-24","2021-06-20","2021-06-18","2021-06-18","2021-09-01","2021-06-18","2021-06-18","2021-09-24","2021-06-18","2021-06-18","2021-06-18","2021-06-21","2021-06-21","2021-06-21","2021-09-24","2021-09-24","2021-09-24","2021-06-04","2021-05-12","2021-05-12","2021-06-18"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","51672402504","AMIODARONE","TAB 200MG","","Select","Select",""],["","378021610","FUROSEMIDE","TAB 40MG","","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","","Select","Select",""],["","3089421","ELIQUIS","TAB 5MG","","Select","Select",""],["","76385011350","CARVEDILOL","TAB 25MG","","Select","Select",""],["","24658031205","DOXYCYCL HYC","TAB 100MG","","Select","Select",""],["","65862020390","LOSARTAN POT","TAB 100MG","","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","","Select","Select",""],["","76385011350","CARVEDILOL ","TAB 25MG","180","Select","Select",""],["","51672402504","AMIODARONE ","TAB 200MG","90","Select","Select",""],["","3089421","ELIQUIS ","TAB 5MG","60","Select","Select",""],["","378020810","FUROSEMIDE ","TAB 20MG","30","Select","Select",""],["","68180072003","AMLODIPINE ","TAB 5MG","90","Select","Select",""],["","603497528","OXYBUTYNIN ","TAB 5MG","30","Select","Select",""],["","65862020390","LOSARTAN ","TAB 100MG","90","Select","Select",""],["","24658031205","DOXYCYCL ","TAB 100MG","24","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","24","Select","Select",""],["","00603497528","OXYBUTYNIN","5MG","30","Select","Select",""],["","65862020390","LOSARTAN","100MG","90","Select","Select",""],["","24658031205","DOXYCYCL","100MG","24","Select","Select",""],["","65862050320","AMOX\/K","875-125","24","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":""}]}]}