{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ESKANDAR SAEIDI","gend":0,"add":"12202 CHEWNING LANE","city":"FREDERICKSBURG","state":"VA","zip":"22407-7207","dob":"1937-03-11","age":"","mstatus":"","insh":11015980,"cliId":"1UT1Q67JY92","pno":5404550736,"cno":5405480672,"email":"","ename":"","eno":"","pphy":"AMEEN, RICHARD J","ppno":5407869771,"pcpadd":"12006 Kilarney Dr","pcpcity":"Fredericksburg","pcpstate":"VA","pcpzip":224077207,"pcpcounty":"","pcpid":"P0124286","pcpname":"CHANCELLOR INTERNAL MEDICINE","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"FREDERICKSBURG","mstate":"VA","mzip":"22407-6610","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["Z23","E11.319","G30.1","N18.31","E03.9","Z00.00","I10","I25.10"],"date":["2020-10-13","2021-05-20","2020-10-28","2021-05-19","2020-10-28","2021-05-19","2021-05-19","2021-05-20"],"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":[["","99073070827","FREESTYLE","TES LITE","","Select","Select",""],["","71858002004","TIROSINT","CAP 75MCG","","Select","Select",""],["","68645058259","METFORMIN","TAB 500MG","","Select","Select",""],["","47781064690","LEVOTHYROXIN","TAB 75MCG","","Select","Select",""],["","93720210","PRAVASTATIN","TAB 40MG","","Select","Select",""],["","68645055654","LISINOP\/HCTZ","TAB 10-12.5","","Select","Select",""],["","68645057454","GLIPIZIDE","TAB 5MG","","Select","Select",""],["","53746016960","MEMANTINE","TAB HCL 10MG","","Select","Select",""],["","16714008110","HYDROXYZ HCL","TAB 10MG","","Select","Select",""],["","68645055654","LISINOP\/HCTZ ","TAB 10-12.5","90","Select","Select",""],["","68645057454","GLIPIZIDE ","TAB 5MG","180","Select","Select",""],["","53746016960","MEMANTINE ","TAB HCL 10MG","180","Select","Select",""],["","93720210","PRAVASTATIN ","TAB 40MG","90","Select","Select",""],["","68645058259","METFORMIN ","TAB 500MG","180","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","TES LITE","100","Select","Select",""],["","47781064690","LEVOTHYROXIN ","TAB 75MCG","90","Select","Select",""],["","71858002004","TIROSINT ","CAP 75MCG","90","Select","Select",""],["","16714008110","HYDROXYZ ","TAB 10MG","30","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":[[["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["No","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":""}]}]}