{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ABDUL   JABAR WALI","gend":0,"add":"102 KARLEY PLACE","city":"YORKTOWN","state":"VA","zip":"23692-5715","dob":"1962-11-30","age":"","mstatus":"","insh":8187862,"cliId":"","pno":7579074825,"cno":7579074825,"email":"","ename":"","eno":"","pphy":"HOSKOTE, NAGRAJ","ppno":7572344285,"pcpadd":"12652 Jefferson Avenue, ","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":236024392,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"TIDEWATER","aligned":"","ano":"","add2":"APARTMENT I","add3":"","madd1":"102 KARLEY PLACE","madd2":"APARTMENT I","madd3":"","mcity":"YORKTOWN","mstate":"VA","mzip":"23692-5715","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25.561","G89.29","S83.511A","S83.241A","I10","G47.00","E78.2","K21.9","F33.2","R79.89","M23.91","S83.411A","R30.0","R39.15","R31.9","E29.1","Z00.00","L73.9","N35.919","L02.02","L02.92","L08.9","Z12.11","G43.009","S83.91XA","W19.XXXA","M17.11","Z23","N52.8","R39.9","F33.0","S83.231A","E55.9","Z13.1"],"date":["2020-10-26","2020-10-26","2020-10-22","2020-10-22","2021-01-06","2020-07-15","2021-01-06","2021-01-06","2020-07-15","2020-07-15","2020-08-25","2020-09-24","2020-10-22","2020-10-22","2020-10-22","2020-12-28","2021-01-06","2021-01-06","2020-12-28","2020-10-16","2020-10-16","2020-10-16","2021-03-15","2021-04-13","2020-08-13","2020-08-14","2020-09-08","2021-04-17","2020-12-28","2020-10-22","2019-01-02","2020-08-25","2021-01-06","2021-01-06"],"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":[["","50111043401","TRAZODONE ","TAB 100MG","30","Select","Select",""],["","65862020199","LOSARTAN ","TAB 25MG","30","Select","Select",""],["","00093077198","PRAVASTATIN ","TAB 10MG","30","Select","Select",""],["","00781808926","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","00574110404","BROM\/PSE\/DM ","SYP ","120","Select","Select",""],["","69238101302","TESTOSTERONE ","GEL 0.0162","75","Select","Select",""],["","00172572860","FAMOTIDINE ","TAB 20MG","60","Select","Select",""],["","64380080807","IBUPROFEN ","TAB 600MG","90","Select","Select",""],["","61314062810","POLYMYXIN ","SOL TRIMETHP","10","Select","Select",""],["","65862015901","ZOLPIDEM ","TAB 5MG","30","Select","Select",""],["","62175011843","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","00093101042","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","52817033010","CYCLOBENZAPR ","TAB 5MG","14","Select","Select",""],["","24208035805","ZYLET ","SUS 0.5-0.3%","5","Select","Select",""],["","00143980305","DOXYCYCL ","CAP 100MG","14","Select","Select",""],["","00363017508","PAIN ","TAB 500MG","45","Select","Select",""],["","49281071910","FLUBLOK ","INJ 2019-20","0.5","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","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}