{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KHADIJA LEATHERBURY","gend":1,"add":"13027 TAXI DRIVE  ","city":"WOODBRIDGE  ","state":"VA","zip":"22193-9998","dob":"1951-11-05","age":"","mstatus":"","insh":11014798,"cliId":"6WE9MQ8RA12","pno":7039923647,"cno":7039923647,"email":"","ename":"","eno":"","pphy":"BOMMASANI, REENA R","ppno":7037302000,"pcpadd":"13168 Centerpointe Way Ste 101","pcpcity":"Woodbridge  ","pcpstate":"VA","pcpzip":221935287,"pcpcounty":"","pcpid":"P0060397","pcpname":"MILLENIUM MEDICAL CORPORATION","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"13027 TAXI DRIVE  ","madd2":"","madd3":"","mcity":"WOODBRIDGE  ","mstate":"VA","mzip":"22193-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["ASIAN\/PACIFIC"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["E11.9","E78.00","I10","I50.9","M25.561","M25.571","Z12.39","M25.511","Z13.820","L29.9","R51.9","M25.562","Z00.00","Z01.00","N17.9","N28.9","N28.1","M54.5","I50.30","Z23","I50.31","R06.02","R07.9","R00.2","E66.01","Z12.31","Z01.812","R94.39","I11.0","E11.3293","D64.9","I12.9","M25.569","N18.32"],"date":["2021-11-16","2021-11-16","2021-10-12","2021-11-16","2021-06-16","2020-10-19","2020-10-19","2020-10-19","2021-06-28","2021-10-12","2020-10-19","2020-10-19","2020-10-19","2020-10-19","2021-02-22","2021-07-09","2020-11-30","2021-02-15","2021-02-22","2021-03-24","2021-07-16","2021-05-27","2021-05-27","2021-07-09","2021-11-16","2021-06-28","2021-07-06","2021-07-16","2021-07-09","2021-08-12","2021-11-16","2021-11-16","2021-11-16","2021-11-16"],"priorHcc":[null,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":[["","70377000315","SIMVASTATIN","TAB 20MG","","Select","Select",""],["","6057761","JANUMET","TAB 50-1000","","Select","Select",""],["","69097012203","TOPIRAMATE","TAB 25MG","","Select","Select",""],["","68180051901","LISINOP\/HCTZ","TAB 20-12.5","","Select","Select",""],["","93317431","ALBUTEROL SUL","FAT E","","Select","Select",""],["","65162044210","MECLIZINE","TAB 25MG","","Select","Select",""],["","57664016758","METOPROL TAR","TAB 100MG","","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","","Select","Select",""],["","378021610","FUROSEMIDE","TAB 40MG","","Select","Select",""],["","45802046564","KETOCONAZOLE","SHA 0.02","","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","","Select","Select",""],["","6011231","JANUVIA","TAB 50MG","","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","","Select","Select",""],["","70377000315","SIMVASTATIN ","TAB 20MG","90","Select","Select",""],["","68180051901","LISINOP\/HCTZ ","TAB 20-12.5","180","Select","Select",""],["","6011231","JANUVIA ","TAB 50MG","90","Select","Select",""],["","69097012203","TOPIRAMATE ","TAB 25MG","30","Select","Select",""],["","6057761","JANUMET ","TAB 50-1000","180","Select","Select",""],["","93317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","69097052444","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","45802046564","KETOCONAZOLE ","SHA 0.02","240","Select","Select",""],["","57664047758","METOPROL ","TAB 50MG","270","Select","Select",""],["","378021610","FUROSEMIDE ","TAB 40MG","90","Select","Select",""],["","65162044210","MECLIZINE ","TAB 25MG","60","Select","Select",""],["","49483060450","IBUPROFEN ","TAB 800MG","180","Select","Select",""],["","57664047758","METOPROL","50MG","270","Select","Select",""],["","23155000201","HYDRALAZINE","25MG","270","Select","Select",""],["","68382065005","ISOSORB","30MG ER","90","Select","Select",""],["","23155000201","HYDRALAZINE ","TAB 25MG","270","Select","Select",""],["","68382065005","ISOSORB ","TAB 30MG ER","90","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":""}]}]}