{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HECTOR HERNANDEZ","gend":0,"add":"1818 MYLTON AVE","city":"WOODBRIDGE  ","state":"VA","zip":"22191-9998","dob":"1941-02-26","age":"","mstatus":"","insh":11010494,"cliId":"4RC2RN7FJ07","pno":7032312785,"cno":5712413168,"email":"","ename":"","eno":"","pphy":"FARTASH, SIMA  ","ppno":7039107390,"pcpadd":"2200 Opitz Blvd Ste 235","pcpcity":"Woodbridge  ","pcpstate":"VA","pcpzip":221913343,"pcpcounty":"","pcpid":"P0124203","pcpname":"WOODBRIDGE INTERNAL MEDICINE PC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1818 MYLTON AVE","madd2":"","madd3":"","mcity":"WOODBRIDGE  ","mstate":"VA","mzip":"22191-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["N40.1","Z68.39","E66.09","Z87.891","N41.0","E11.21","E11.42","E11.9","M25.572","E78.2","I10","H26.9","Z91.81","Z13.31","Z02.9","F17.210","Z01.818","Z01.89","Z01.812","E87.1","E78.5","F03.90","R42","Z23","M25.472","G30.1","Z00.00","Z12.11","R06.09","E11.65"],"date":["2021-04-05","2020-10-01","2020-10-01","2020-09-11","2021-03-29","2020-01-21","2020-01-21","2021-04-05","2020-02-03","2020-02-12","2021-04-05","2020-02-21","2020-10-01","2020-10-01","2020-02-12","2020-02-12","2020-02-21","2020-02-21","2020-02-21","2021-04-05","2021-04-05","2020-09-08","2020-10-01","2020-09-11","2020-10-01","2020-10-01","2020-10-01","2020-10-01","2021-04-05","2021-04-05"],"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":[["","43547027611","DONEPEZIL","TAB 10MG","","Select","Select",""],["","68645057559","GLIPIZIDE","TAB 10MG","","Select","Select",""],["","6027731","JANUVIA","TAB 100MG","","Select","Select",""],["","68382005105","MELOXICAM","TAB 15MG","","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","","Select","Select",""],["","68382013201","TAMSULOSIN","CAP 0.4MG","","Select","Select",""],["","93505698","ATORVASTATIN","TAB 10MG","","Select","Select",""],["","59746012106","MECLIZINE","TAB 25MG","","Select","Select",""],["","53885027025","ONETOUCH","TES VERIO","","Select","Select",""],["","53885001110","ONETOUCH DEL","MIS PLUS 30G","","Select","Select",""],["","29300015501","ALFUZOSIN","TAB 10MG ER","","Select","Select",""],["","45802014167","CICLOPIROX","SOL 0.08","","Select","Select",""],["","43547027611","DONEPEZIL ","TAB 10MG","90","Select","Select",""],["","68382005105","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","68645057559","GLIPIZIDE ","TAB 10MG","90","Select","Select",""],["","6027731","JANUVIA ","TAB 100MG","90","Select","Select",""],["","57237011490","ALFUZOSIN ","TAB 10MG ER","90","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50\/0.5ML","1","Select","Select",""],["","68382013201","TAMSULOSIN ","CAP 0.4MG","90","Select","Select",""],["","93505698","ATORVASTATIN ","TAB 10MG","90","Select","Select",""],["","53885027210","ONETOUCH ","TES VERIO","100","Select","Select",""],["","59746012106","MECLIZINE ","TAB 25MG","42","Select","Select",""],["","45802014167","CICLOPIROX ","SOL 0.08","6.6","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","",""],["No","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":""}]}]}