{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SYNINA   L CLARK","gend":1,"add":"4251 DUKE STREET","city":"ALEXANDRIA","state":"VA","zip":"22304-2483","dob":"1977-01-31","age":"","mstatus":"","insh":10068518,"cliId":"","pno":2026792488,"cno":2026792488,"email":"","ename":"","eno":"","pphy":"TRUONG, HUY TIN","ppno":"               ","pcpadd":", ","pcpcity":"Alexandria","pcpstate":"VA","pcpzip":223041634,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"NORTHERN\/ WINCHESTER","aligned":"","ano":"","add2":"APARTMENT D9","add3":"","madd1":"296 S Whiting St Apt V14","madd2":"                                                            ","madd3":"","mcity":"Alexandria","mstate":"VA","mzip":"22304-3608","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.32","J40","M54.5","H92.01","H66.91","Z12.4","R92.8","N92.6","N89.8","D21.9","R87.610","H66.90","F17.290","Z21","K11.20","F17.210","B20","J45.30","F32.2","F41.1","H40.9","D25.9","Z79.899","Z00.00","R92.1","E55.9","Z01.419","Z11.3","Z12.39","F32.9","R05","Z72.0","F17.200","R59.0","S39.012A","D25.1","N39.0","R31.9","M79.602","R42","R00.2","G89.29","S69.92XA","W23.1XXA","S61.317A"],"date":["2019-03-08","2019-05-25","2020-06-19","2020-11-04","2020-10-22","2020-12-01","2020-12-01","2020-12-01","2020-12-01","2020-12-01","2020-12-01","2020-10-22","2020-10-22","2020-10-22","2020-11-04","2020-11-04","2021-05-11","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2021-05-11","2020-11-11","2020-11-11","2020-12-01","2020-12-01","2020-12-01","2020-11-03","2020-02-10","2020-02-10","2020-11-03","2019-05-25","2020-01-16","2020-01-16","2020-01-16","2020-01-16","2019-09-26","2020-02-18","2020-02-18","2020-06-19","2021-04-21","2021-04-21","2021-04-23"],"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":[["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","61958190101","GENVOYA ","TAB ","30","Select","Select",""],["","66993058597","FLUTIC\/SALME ","AER 250\/50","1","Select","Select",""],["","40985027288","VITAMIN ","TAB 5000UNIT","90","Select","Select",""],["","61958250101","BIKTARVY ","TAB ","30","Select","Select",""],["","63304069301","CLINDAMYCIN ","CAP 300MG","30","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","57237001930","DULOXETINE ","CAP 60MG","30","Select","Select",""],["","68462015713","ONDANSETRON ","TAB 4MG ODT","30","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","30","Select","Select",""],["","29300012510","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","00173069600","ADVAIR ","AER 250\/50","60","Select","Select",""],["","65162062750","TRAMADOL ","TAB 50MG","28","Select","Select",""],["","64679096101","AZITHROMYCIN ","TAB 250MG","4","Select","Select",""],["","00406048410","APAP\/CODEINE ","TAB 300-30MG","10","Select","Select",""],["","64380080807","IBUPROFEN ","TAB 600MG","15","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","00781707787","METRONIDAZOL ","GEL 0.75%VAG","70","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","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}