{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VIRGINIA ALEMAN DE DEL","gend":1,"add":"9730 BRAGG LN","city":"MANASSAS","state":"VA","zip":"20110-9998","dob":"1951-10-31","age":"","mstatus":"","insh":"900035508*01","cliId":"7H18QA4HK67","pno":"571\/290-9524","cno":"571\/290-9524","email":"","ename":"","eno":"","pphy":"FAROOQUE, ABDULLAH MD","ppno":"703\/393-8883","pcpadd":"STE 105 8609 SUDLEY RD","pcpcity":"MANASSAS","pcpstate":"VA","pcpzip":20110,"pcpcounty":"","pcpid":121052,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"866\/765-1362","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N18.3","D50.8","R80.0","I10.","E83.52","E78.00","E11.9","Z79.4","R80.9","E87.2","K76.9","E55.9","Z00.00","Z23.","E11.3599","G62.9","E11.3553"],"date":["2021-06-07","2019-12-02","2019-08-23","2021-07-22","2019-09-26","2021-07-22","2021-06-07","2021-07-22","2020-02-13","2020-02-13","2021-06-07","2021-07-22","2021-07-22","2021-04-11","2021-07-22","2021-07-22","2021-07-22"],"priorHcc":["","","",null,"",null,"",null,"","","",null,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":[["","68645058259","METFORMIN","TAB 500MG","60","Select","Select",""],["","67877022210","GABAPENTIN","CAP 100MG","30","Select","Select",""],["","93505798","ATORVASTATIN","TAB 80MG","90","Select","Select",""],["","169183702","NOVOLIN70\/30","INJ RELION","140","Select","Select",""],["","81131013834","INSULIN SYRG","MIS 1ML\/31G","200","Select","Select",""],["","8317700100","RELION PRIME","TES GLUCOSE","-200","Select","Select",""],["","72205000530","ROSUVASTATIN","TAB 40MG","90","Select","Select",""],["","68645055354","LISINOPRIL","TAB 20MG","90","Select","Select",""],["","68382009505","CARVEDILOL","TAB 25MG","60","Select","Select",""],["","68645051554","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","38396045202","RELION LANCE","MIS THIN 30G","-200","Select","Select",""],["","49281012065","FLUZONE HD","INJ PF 20-21","-1","Select","Select",""],["","49281072010","FLUBLOK QUAD","INJ 2020-21","0","Select","Select",""],["","58160082311","SHINGRIX","INJ 50MCG","1","Select","Select",""],["","64980029410","SODIUM BICAR","TAB 10GR","60","Select","Select",""],["","78742026442","RELION ULTRA","MIS THIN 30G","200","Select","Select",""],["","13703015271","SYRINGE","MIS 0.5\/30G","-200","Select","Select",""],["","8317700050","RELION PRIME BLOOD GLUCOSE TEST STRIPS","","200","Select","Select",""],["","169183702","NOVOLIN 70\/30 RELION ","","40","Select","Select",""],["","68645049554","ATORVASTATIN CALCIUM ","","90","Select","Select",""],["","68645051654","AMLODIPINE BESYLATE","","30","Select","Select",""],["","72205000530","ROSUVASTATIN CALCIUM ","","90","Select","Select",""],["","81131013834","RELION INSULIN SYRINGE 1ML\/31GX15\/64\" ","","200","Select","Select",""],["","49281040565","FLUZONE HIGH-DOSE PF 2019-2020","","0","Select","Select",""],["","64980029410","SODIUM BICARBONATE ","","60","Select","Select",""],["","68645058259","METFORMIN HYDROCHLORIDE","","60","Select","Select",""],["","49281012065","FLUZONE HIGH-DOSE PF 2020-2021","","1","Select","Select",""],["","49281072010","FLUBLOK QUADRIVALENT 2020-2021","","0","Select","Select",""],["","38396045202","RELION LANCETS ULTRA-THIN30G","","200","Select","Select",""],["","8290324912","BD VEO INSULIN SYRINGE ULTRA-FINE\/1ML\/31G X 6MM","","200","Select","Select",""],["","13703015271","VANISHPOINT INSULIN SYRINGE\/0.5ML\/30G X 5\/16\" ","","200","Select","Select",""],["","78742026442","RELION ULTRA THIN LANCETS\/30G","","200","Select","Select",""],["","68645049554","ATORVASTATIN CALCIUM","","90","Select","Select",""],["","00169183702","NOVOLIN 70\/30 RELION","","130","Select","Select",""],["","81131013834","RELION INSULIN SYRINGE 1ML\/31GX15\/64\"","","200","Select","Select",""],["","64980029410","SODIUM BICARBONATE","","60","Select","Select",""],["","72205000530","ROSUVASTATIN CALCIUM","","90","Select","Select",""],["","13703015271","VANISHPOINT INSULIN SYRINGE\/0.5ML\/30G X 5\/16\"","","-200","Select","Select",""],["","81131031175","RELION INSULIN SYRINGE\/U-100\/1ML\/31G X 5\/16\"","","-200","Select","Select",""],["","68645049554","ATORVASTATIN CALCIUM                                                  ","TAB 80MG","30","Select","Select",""],["","00169183702","NOVOLIN 70\/30 RELION                                                  ","INJ RELION","40","Select","Select",""],["","08317700050","RELION PRIME BLOOD GLUCOSE TEST STRIPS                                ","TES ","200","Select","Select",""],["","72205000530","ROSUVASTATIN CALCIUM                                                  ","TAB 40MG","90","Select","Select",""],["","68382009505","CARVEDILOL                                                            ","TAB 25MG","60","Select","Select",""],["","67877022210","GABAPENTIN                                                            ","CAP 100MG","-30","Select","Select",""],["","00591040810","LISINOPRIL                                                            ","TAB 20MG","90","Select","Select",""],["","68645058259","METFORMIN HYDROCHLORIDE                                               ","TAB 500MG","60","Select","Select",""],["","81131013834","RELION INSULIN SYRINGE 1ML\/31GX15\/64\"                                 ","MIS 1ML\/31G","200","Select","Select",""],["","49281012065","FLUZONE HIGH-DOSE PF 2020-2021                                        ","INJ PF 20-21","-1","Select","Select",""],["","68645051554","AMLODIPINE BESYLATE                                                   ","TAB 5MG","90","Select","Select",""],["","49281072010","FLUBLOK QUADRIVALENT 2020-2021                                        ","INJ 2020-21","0","Select","Select",""],["","08290324912","BD VEO INSULIN SYRINGE ULTRA-FINE\/1ML\/31G X 6MM                       ","MIS 1ML\/31G","200","Select","Select",""],["","38396045202","RELION LANCETS ULTRA-THIN30G                                          ","MIS THIN 30G","-200","Select","Select",""],["","78742026442","RELION ULTRA THIN LANCETS\/30G                                         ","MIS THIN 30G","200","Select","Select",""],["","13703015271","VANISHPOINT INSULIN SYRINGE\/0.5ML\/30G X 5\/16\"                         ","MIS 0.5\/30G","-200","Select","Select",""],["","81131031175","RELION INSULIN SYRINGE\/U-100\/1ML\/31G X 5\/16\"                          ","MIS 1ML\/31G","200","Select","Select",""],["","10702001801","OXYCODONE HYDROCHLORIDE                                               ","TAB 5MG","20","Select","Select",""],["","00088222033","LANTUS                                                                ","INJ 100\/ML","10","Select","Select",""],["","00002751001","HUMALOG                                                               ","INJ 100\/ML","10","Select","Select",""],["","00603188016","LIDOCAINE                                                             ","PAD 0.05","12","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":""}]}]}