{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CUONG   N HOANG","gend":0,"add":"8630 HILLSIDE MANOR DR","city":"SPRINGFIELD","state":"VA","zip":"22152-9998","dob":"1949-10-02","age":"","mstatus":"","insh":"900038333*01","cliId":"5PD4P46NK89","pno":"617\/605-1454","cno":"617\/605-1454","email":"","ename":"","eno":"","pphy":"PHAM, SEAN MD","ppno":"571\/423-5750","pcpadd":"6355 WALKER LANE SUITE 500","pcpcity":"ALEXANDRIA","pcpstate":"VA","pcpzip":22310,"pcpcounty":"","pcpid":199476,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"703\/922-3479","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z12.2","I71.2","R91.1","Z87.891","H26.491","H26.492","M77.11","Z23.","Z00.00","Z13.6","Z11.59","Z12.5","F17.200","R35.1","I10.","D49.2","H26.8","Z12.11","H01.02A","H01.02B","H35.361","L30.9","M54.50","K05.30","N52.9","G89.29"],"date":["2020-03-04","2020-08-12","2021-10-29","2021-10-29","2021-04-20","2021-04-06","2020-02-24","2020-02-24","2021-10-06","2021-10-06","2020-08-12","2020-08-12","2021-10-06","2020-08-12","2021-10-06","2020-08-12","2020-08-12","2021-10-08","2021-09-07","2021-09-07","2021-09-07","2021-10-06","2021-10-06","2021-10-06","2021-10-06","2021-10-06"],"priorHcc":["","",null,null,"","","","",null,null,"","",null,"",null,"","",null,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":[["","68180072103","AMLODIPINE ","10MG","90","Select","Select",""],["","50742061510","METOPROL ","25MG ER","90","Select","Select",""],["","60758011905","PREDNISOLONE ","1% OP","5","Select","Select",""],["","49281012165","FLUZONE ","2021-22","1","Select","Select",""],["","68180072103","","10MG","90","Select","Select",""],["","68180072103","AMLODIPINE","10MG","90","Select","Select",""],["","50742061510","METOPROL","25MG ER","90","Select","Select",""],["","60758011905","PREDNISOLONE","1% OP","-5","Select","Select",""],["","49281012165","FLUZONE","2021-22","-1","Select","Select",""],["","00093534256","SILDENAFIL","50MG","6","Select","Select",""],["","51672404801","CLOTRIM\/BETA","DIPROP","15","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","00093534256","SILDENAFIL ","TAB 50MG","6","Select","Select",""],["","51672404801","CLOTRIM\/BETA ","CRE DIPROP","15","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","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","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":""}]}]}