{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" CAN V NGUYEN","gend":0,"add":"109 S HUDSON ST","city":"ALEXANDRIA","state":"VA","zip":"22304-9998","dob":"1944-09-15","age":"","mstatus":"","insh":"900036384*01","cliId":"","pno":"757\/536-3165","cno":"757\/536-3165, ","email":"","ename":"","eno":"","pphy":"NGUYEN, NGOC HA MD","ppno":"703\/642-3220","pcpadd":"7202 C POPLAR ST","pcpcity":"ANNANDALE","pcpstate":"VA","pcpzip":"22003-9998","pcpcounty":"","pcpid":173695,"pcpname":"","plan":"OHP - OPTIMA","program":"MEDICARE","lob":"MA-NON DSNP","region":"NORTHERN\/ WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E78.2","I10.","E11.9","I25.10","I77.810","R07.9","Z00.00","E78.5","D64.9","E11.65","E03.9","R06.02","H04.123","I44.0","I77.819","D69.6"],"date":["2021-06-21","2021-06-21","2021-06-21","2021-03-22","2021-03-22","2020-10-16","2020-07-09","2020-12-21","2020-11-13","2020-11-13","2020-11-13","2020-11-20","2021-04-27","2020-02-06","2020-02-06","2020-07-09"],"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":[["","60505014101","GLIPIZIDE ","5MG","90","Select","Select",""],["","23155010209","METFORMIN ","500MG","180","Select","Select",""],["","16729000617","SIMVASTATIN ","40MG","90","Select","Select",""],["","45963070996","METOPROL ","25MG ER","90","Select","Select",""],["","00378292293","TELMISARTAN ","80MG","90","Select","Select",""],["","53885024510","ONETOUCH ","ULTRA BL","100","Select","Select",""],["","49281012065","FLUZONE ","PF 20-21","1","Select","Select",""],["","59762330403","NITROGLYCERN ","0.4MG","-150","Select","Select",""],["","60505258008","ATORVASTATIN ","40MG","90","Select","Select",""],["","80777027310","MODERNA ","COVID-19","0","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","",""],["No","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":""}]}]}