{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"THU D TRAN","gend":1,"add":"11609 VALE ROAD","city":"OAKTON","state":"VA","zip":"22124-9998","dob":"1988-06-03","age":"","mstatus":"","insh":11015812,"cliId":"9C60MP4KK43","pno":7035688733,"cno":7035688733,"email":"","ename":"","eno":"","pphy":"NGUYEN, HONG T ","ppno":5407869771,"pcpadd":"12006 Kilarney Dr","pcpcity":"Fredericksburg ","pcpstate":"VA","pcpzip":224077207,"pcpcounty":"","pcpid":"P0124286","pcpname":"CHANCELLOR INTERNAL MEDICINE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"11609 VALE ROAD","madd2":"","madd3":"","mcity":"OAKTON","mstate":"VA","mzip":"22124-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["ASIAN\/PACIFIC"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["Z00.00","L30.9","R10.11","E78.2","E55.9","J30.9","R05","D47.3","H01.02A","H01.024","H16.223","H53.8","H57.13","R10.31","R21","L23.7","J30.2","L50.9","L23.9","L29.8","J30.89","J30.1"],"date":["2021-03-29","2021-09-23","2020-09-29","2021-03-24","2021-03-29","2021-03-29","2021-09-11","2021-03-29","2021-03-22","2021-03-22","2021-03-22","2021-03-22","2021-03-22","2021-08-26","2021-09-11","2021-09-11","2021-09-11","2021-10-15","2021-10-27","2021-10-27","2021-10-27","2021-10-27"],"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":[["","45802049326","AMMONIUM LAC","CRE 0.12","","Select","Select",""],["","45802006435","TRIAMCINOLON","CRE 0.001","","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","","Select","Select",""],["","45802006435","TRIAMCINOLON ","CRE 0.001","45","Select","Select",""],["","45802049326","AMMONIUM ","CRE 0.12","385","Select","Select",""],["","65862057490","MONTELUKAST ","TAB 10MG","90","Select","Select",""],["","45802049326","AMMONIUM","0.12","385","Select","Select",""],["","59746017206","PREDNISONE","5MG","20","Select","Select",""],["","16714008210","HYDROXYZ","25MG","30","Select","Select",""],["","49281042150","FLUZONE","2021-22","0.5","Select","Select",""],["","16714008210","HYDROXYZ ","TAB 25MG","30","Select","Select",""],["","59746017206","PREDNISONE ","TAB 5MG","20","Select","Select",""],["","49281042150","FLUZONE ","INJ 2021-22","0.5","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":""}]}]}