{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GLORIA TILLIS","gend":1,"add":"6700 Metropolitan Center Dr Apt 309","city":"Springfield                   ","state":"VA","zip":"22150-4586","dob":"1954-08-23","age":"","mstatus":"","insh":11018323,"cliId":"7U18CN6DM58","pno":2403867595,"cno":2403867595,"email":"","ename":"","eno":"","pphy":"KIM, PETER D","ppno":7036422288,"pcpadd":"4208 Evergreen Ln Ste 222,","pcpcity":"Annandale","pcpstate":"VA","pcpzip":220033251,"pcpcounty":"","pcpid":"P0124900","pcpname":"PETER D KIM MD PC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"APT 309","add3":"","madd1":"6700 Metropolitan Center Dr Apt 309","madd2":"APT 309","madd3":"","mcity":"Springfield","mstate":"VA","mzip":"22150-4586","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.65","R35.0","E11.42","G44.209","R06.83","G43.109","I67.82","I10","K21.9","E78.2","E66.09","Z12.31","G47.61","G47.33","R90.82"],"date":["2021-08-25","2021-08-25","2021-08-25","2021-10-01","2021-09-03","2021-08-02","2021-08-19","2021-08-25","2021-08-25","2021-08-25","2021-08-25","2021-10-07","2021-09-03","2021-10-01","2021-10-01"],"priorHcc":["","","",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":[["","67877019705","AMLODIPINE","2.5MG","90","Select","Select",""],["","72205001490","PREGABALIN","100MG","90","Select","Select",""],["","70710111108","TIZANIDINE","2MG","60","Select","Select",""],["","00093505898","ATORVASTATIN","40MG","90","Select","Select",""],["","00006027731","JANUVIA","100MG","90","Select","Select",""],["","00781286810","OMEPRAZOLE","20MG","60","Select","Select",""],["","68645055754","LISINOP\/HCTZ","20-12.5","180","Select","Select",""],["","00597015330","JARDIANCE","25MG","90","Select","Select",""],["","53885000810","ONETOUCH","PLUS 33G","200","Select","Select",""],["","68645057390","GLIMEPIRIDE","4MG","90","Select","Select",""],["","69315031228","PROCTO-MED","HC 2.5%","28","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":""}]}]}