{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EZAT ETEDALI","gend":1,"add":"1172 WINDROCK DR  ","city":"MACLEAN  ","state":"VA","zip":"22102-9998","dob":"1937-05-21","age":"","mstatus":"","insh":11018166,"cliId":"8U35QK7JQ83","pno":7039579060,"cno":7039579060,"email":"","ename":"","eno":"","pphy":"KITAY, KALEEN  ","ppno":7032883750,"pcpadd":"6862 Elm St Ste 700","pcpcity":"McLean","pcpstate":"VA","pcpzip":221013862,"pcpcounty":"","pcpid":"P0130340","pcpname":"PARTNER MD PC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"1172   WINDROCK DRIVE","add3":"","madd1":"1172 WINDROCK DR  ","madd2":"1172   WINDROCK DRIVE","madd3":"","mcity":"MACLEAN  ","mstate":"VA","mzip":"22102-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N18.6","Z99.2","C91.12","D64.9","R53.1","E03.9","E11.22","I12.9","N18.4","Z79.82","Z79.84","Z85.6","Z79.890","N39.41","M62.81","R15.9","N32.81","N39.46","Z49.02","I12.0","Z86.73","K21.9","C91.10","D63.1","N18.5","R06.02","D50.9","N25.81","R94.31","T85.611A","E08.65","D48.1","Z23","R26.9","C95.91","I63.9","I47.1","I21.A1","R07.2","I51.7","I50.30","I08.1","R00.0","M48.061","R26.89","N39.0","Z91.81","R07.9","Z74.3","E87.1","I24.8","D63.0","E78.5","M65.9","B96.1"],"date":["2021-11-21","2021-11-21","2021-09-29","2021-09-29","2021-06-04","2021-10-16","2021-11-21","2021-07-19","2021-09-29","2021-10-16","2021-11-21","2021-06-04","2021-07-19","2021-11-09","2021-11-21","2021-11-09","2021-11-09","2021-11-09","2021-11-14","2021-11-21","2021-11-21","2021-10-16","2021-10-16","2021-11-21","2021-07-13","2021-07-19","2021-10-01","2021-09-01","2021-07-19","2021-06-29","2021-07-13","2021-07-29","2021-10-01","2021-09-13","2021-09-13","2021-09-13","2021-11-21","2021-10-17","2021-10-16","2021-10-16","2021-10-16","2021-10-16","2021-10-16","2021-11-21","2021-11-21","2021-11-21","2021-11-21","2021-10-15","2021-10-15","2021-10-16","2021-10-16","2021-10-16","2021-10-16","2021-10-16","2021-10-16"],"priorHcc":[null,null,"","","",null,null,"","",null,null,"","",null,null,null,null,null,null,null,null,null,null,null,"","",null,"","","","","",null,"","","",null,"","","","","","",null,null,null,null,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":[]},{"a":[]}]},{"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":[["","378395205","ATORVASTATIN ","40MG","30","Select","Select",""],["","69238183107","LEVOTHYROXIN ","50MCG","30","Select","Select",""],["","64764024060","AMITIZA ","24MCG","60","Select","Select",""],["","781108901","ALPRAZOLAM ","2MG","30","Select","Select",""],["","6011228","JANUVIA ","50MG","30","Select","Select",""],["","00378395205","ATORVASTATIN","40MG","30","Select","Select",""],["","64764024060","AMITIZA","24MCG","60","Select","Select",""],["","69238183107","LEVOTHYROXIN","50MCG","30","Select","Select",""],["","65862067899","ALPRAZOLAM","1MG","60","Select","Select",""],["","00006011228","JANUVIA","50MG","30","Select","Select",""],["","00310051260","CALQUENCE","100MG","45","Select","Select",""],["","69097081312","GABAPENTIN","100MG","60","Select","Select",""],["","00310051260","CALQUENCE ","CAP 100MG","45","Select","Select",""],["","69097081312","GABAPENTIN ","CAP 100MG","60","Select","Select",""],["","00254302902","LUBIPROSTONE ","CAP 24MCG","60","Select","Select",""],["","50742061510","METOPROL ","TAB 25MG ER","30","Select","Select",""],["","62037099901","POT  CL MICRO","TAB 20MEQ ER","30","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","30","Select","Select",""],["","70700015010","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","67877021560","CEFUROXIME ","TAB 250MG","10","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","",""],["No","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":""}]}]}