{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHEILA A SULLIVAN","gend":1,"add":"12007 GREYWING SQUARE","city":"RESTON","state":"VA","zip":"20191-9998","dob":"1947-03-29","age":"","mstatus":"","insh":11012420,"cliId":"9PN7W24JY47","pno":2027440149,"cno":2027440149,"email":"","ename":"","eno":"","pphy":"AGGARWAL, RAJIV K ","ppno":5712233833,"pcpadd":"19415 Deerfield Ave Ste 103","pcpcity":"Lansdowne","pcpstate":"VA","pcpzip":201768470,"pcpcounty":"","pcpid":"P0141011","pcpname":"LANSDOWNE TRAVEL AND FAMILY MEDICINE LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"APARTMENT A2","add3":"","madd1":"12007 GREYWING SQUARE","madd2":"APARTMENT A2","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":["F33.1","F41.1","H11.32","E11.3513","H25.12","H33.41","M25.512","M75.42","F33.41","K21.00","Z00.00","J30.1","E78.2","R41.89","K14.0","B37.0","Z23","L30.9","M19.90","R53.83","K21.9","H25.813","H91.90","G89.4","Z68.26","N39.0","E11.3593","N30.00","Z68.27","L73.8","L72.0","L82.1","L82.0","L53.8","Z78.9","E66.01","E78.5","R73.09","F32.9","K14.6","K13.29","D00.07","C02.3","R94.31"],"date":["2021-07-15","2021-07-15","2020-03-02","2021-01-14","2021-01-14","2021-08-31","2021-04-13","2021-04-13","2021-07-22","2021-07-22","2021-02-10","2021-07-22","2021-05-07","2021-02-15","2021-05-19","2021-05-19","2021-05-19","2020-10-02","2020-10-02","2020-10-02","2021-09-29","2020-10-02","2020-10-02","2020-10-02","2020-10-02","2021-07-22","2021-08-31","2021-06-18","2021-03-05","2021-07-01","2021-07-01","2021-07-01","2021-07-01","2021-07-01","2021-07-01","2021-02-10","2021-09-29","2021-02-10","2021-02-10","2021-09-15","2021-09-29","2021-09-08","2021-09-29","2021-09-23"],"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":[["","13668001001","CITALOPRAM","TAB 20MG","","Select","Select",""],["","185012201","NITROFURANTN","CAP 100MG","","Select","Select",""],["","54327099","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","70461012003","FLUAD QUADRI","INJ 0.5ML","","Select","Select",""],["","378395205","ATORVASTATIN","TAB 40MG","","Select","Select",""],["","143993905","AMOXICILLIN","CAP 500MG","","Select","Select",""],["","13668001001","CITALOPRAM ","TAB 20MG","90","Select","Select",""],["","185012201","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","378395205","ATORVASTATIN ","TAB 40MG","90","Select","Select",""],["","54327099","FLUTICASONE ","SPR 50MCG","48","Select","Select",""],["","70461012003","FLUAD ","INJ 0.5ML","0.5","Select","Select",""],["","143993905","AMOXICILLIN ","CAP 500MG","21","Select","Select",""],["","63304069301","CLINDAMYCIN ","300MG","30","Select","Select",""],["","57237000511","FLUCONAZOLE ","150MG","5","Select","Select",""],["","70461012003","FLUAD","0.5ML","0.5","Select","Select",""],["","66689000802","NYSTATIN","100000","240","Select","Select",""],["","63304069301","CLINDAMYCIN","300MG","30","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","5","Select","Select",""],["","00713065540","TRIAMCINOLON","DEN 0.1%","5","Select","Select",""],["","00000000000","PREDNISOLONE","15MG\/5ML","480","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","20","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","20","Select","Select",""],["","00713065540","TRIAMCINOLON ","PST DEN 0.1%","5","Select","Select",""],["","66689000802","NYSTATIN ","SUS 100000","240","Select","Select",""],["","00000000000","PREDNISOLONE ","SOL 15MG\/5ML","480","Select","Select",""],["","00116200116","CHLORHEX ","SOL 0.0012","473","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":""}]}]}