{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GERMAN S BERRIOS MERINO","gend":0,"add":"6207 THORNWOOD DR ","city":"ALEXANDRIA  ","state":"VA","zip":"22310-9998","dob":"1939-05-02","age":"","mstatus":"","insh":11018342,"cliId":"6NK3H74RU01","pno":5712089433,"cno":7036229452,"email":"","ename":"","eno":"","pphy":"KIM, MICHAEL","ppno":7033913558,"pcpadd":"3600 Joseph Siewick Dr","pcpcity":"Fairfax  ","pcpstate":"VA","pcpzip":220331709,"pcpcounty":"","pcpid":"P0154968","pcpname":"INOVA VIP 360 - SPRINGFIELD","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"6207 THORNWOOD DR ","madd2":"","madd3":"","mcity":"ALEXANDRIA  ","mstate":"VA","mzip":"22310-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","E78.2","C61","R73.03","Z23","Z91.81","Z68.30","E66.09","I25.10","I67.82","R26.81","R26.89","M62.81","J32.2","Z86.16","N40.1","Z00.00","Z13.31","H90.3","J32.9","J34.89","R90.82","E87.5","N40.0","N18.30","Z68.28","J30.1","E78.5","H90.5"],"date":["2021-07-16","2021-07-16","2021-08-19","2021-08-20","2021-07-16","2021-08-20","2021-07-16","2021-07-16","2021-08-20","2021-08-04","2021-08-04","2021-08-04","2021-08-04","2021-08-04","2021-08-04","2021-08-19","2021-08-20","2021-08-20","2021-08-17","2021-08-04","2021-08-04","2021-08-04","2021-08-20","2021-08-20","2021-08-20","2021-08-20","2021-08-20","2021-08-20","2021-08-24"],"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":[]},{"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":[["","43598043611","NITROGLYCERN","0.4MG","25","Select","Select",""],["","00378001805","METOPROL","25MG","90","Select","Select",""],["","31722088530","ROSUVASTATIN","40MG","90","Select","Select",""],["","43547035611","LISINOPRIL","40MG","90","Select","Select",""],["","58160081912","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","68382013201","TAMSULOSIN","0.4MG","90","Select","Select",""],["","31722072690","MONTELUKAST","10MG","90","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","48","Select","Select",""],["","43598043611","NITROGLYCERN ","SUB 0.4MG","25","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","48","Select","Select",""],["","43547035611","LISINOPRIL ","TAB 40MG","90","Select","Select",""],["","00378001805","METOPROL ","TAB 25MG","90","Select","Select",""],["","31722072690","MONTELUKAST ","TAB 10MG","90","Select","Select",""],["","68382013201","TAMSULOSIN ","CAP 0.4MG","90","Select","Select",""],["","31722088530","ROSUVASTATIN ","TAB 40MG","90","Select","Select",""],["","58160081912","SHINGRIX ","INJ 50\/0.5ML","1","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","",""],["Yes","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":""}]}]}