{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARGARET E MARSHALL","gend":1,"add":"7987 ASHTON AVE STE 200 ","city":"MANASSAS ","state":"VA","zip":"20109-9998","dob":"1955-05-24","age":"","mstatus":"","insh":11016999,"cliId":"5WH2VF2CF99","pno":5712255176,"cno":"","email":"","ename":"","eno":"","pphy":"BLECHER, LEE IRWIN","ppno":7033912020,"pcpadd":"3650 Joseph Siewick Dr Ste 400","pcpcity":"Fairfax  ","pcpstate":"VA","pcpzip":220331715,"pcpcounty":"","pcpid":"P0155354","pcpname":"PRINCE WILLIAM FAMILY MEDICINE MANASSAS AN INOVA","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"N","ano":"","add2":"","add3":"","madd1":"7987 ASHTON AVE STE 200 ","madd2":"","madd3":"","mcity":"MANASSAS ","mstate":"VA","mzip":"20109-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["I10","R92.8","I35.0","E78.2","N60.01","N63.12","N60.11","N63.21","N64.89","Z23","Z00.00","N95.9"],"date":["2021-10-25","2021-11-10","2021-02-11","2021-10-25","2021-03-31","2021-03-16","2021-03-16","2021-03-16","2021-04-13","2021-10-25","2021-10-25","2021-10-25"],"priorHcc":[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":[["","57664047758","METOPROL TAR","TAB 50MG","","Select","Select",""],["","66689034599","CHLORTHALID","TAB 25MG","","Select","Select",""],["","93720198","PRAVASTATIN","TAB 20MG","","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","","Select","Select",""],["","68180072003","AMLODIPINE ","TAB 5MG","90","Select","Select",""],["","57664047758","METOPROL ","TAB 50MG","180","Select","Select",""],["","93720198","PRAVASTATIN ","TAB 20MG","90","Select","Select",""],["","64980030310","CHLORTHALID ","TAB 25MG","15","Select","Select",""],["","57664047758","METOPROL","50MG","60","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","",""],["Yes","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":""}]}]}