{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARIA E SANCHEZ BERRIOS","gend":1,"add":"6207 Thornwood Dr ","city":"Alexandria  ","state":"VA","zip":"22310-2961","dob":"1947-12-26","age":"","mstatus":"","insh":11018390,"cliId":"1V72GN4RU81","pno":7036229452,"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":"22310-2961","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","E11.9","E78.5","G30.9","Z23","I12.9","Z68.25","E66.3","Z91.81","Z13.31","Z13.820","E03.9","K21.00","N18.4","E11.22","Z00.00"],"date":["2021-10-07","2021-10-07","2021-10-07","2021-10-07","2021-10-07","2021-10-07","2021-10-07","2021-10-07","2021-10-07","2021-10-07","2021-10-07","2021-10-07","2021-10-07","2021-10-14","2021-10-07","2021-10-07"],"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":[["","43547027609","DONEPEZIL","10MG","90","Select","Select",""],["","68180098103","LISINOPRIL","20MG","90","Select","Select",""],["","00597014860","JENTADUETO","2.5-1000","180","Select","Select",""],["","69238183007","LEVOTHYROXIN","25MCG","90","Select","Select",""],["","31722088490","ROSUVASTATIN","20MG","90","Select","Select",""],["","62175011843","OMEPRAZOLE","20MG","180","Select","Select",""],["","00093727256","PIOGLITAZONE","30MG","90","Select","Select",""],["","31722088490","ROSUVASTATIN ","TAB 20MG","90","Select","Select",""],["","00093727256","PIOGLITAZONE ","TAB 30MG","90","Select","Select",""],["","43547027609","DONEPEZIL ","TAB 10MG","90","Select","Select",""],["","68180098103","LISINOPRIL ","TAB 20MG","90","Select","Select",""],["","00597014860","JENTADUETO ","TAB 2.5-1000","10","Select","Select",""],["","69238183007","LEVOTHYROXIN ","TAB 25MCG","90","Select","Select",""],["","29300012510","MELOXICAM ","TAB 15MG","90","Select","Select",""],["","62175011843","OMEPRAZOLE ","CAP 20MG","180","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":""}]}]}