{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GONZALEZ M DE GARCIA","gend":1,"add":"7751 QUAIL RUN LN","city":"MANASSAS","state":"VA","zip":20109,"dob":"1947-01-04","age":"","mstatus":"","insh":"900038815*01","cliId":"","pno":"571\/243-3743","cno":"571\/243-3743    ","email":"","ename":"","eno":"","pphy":"KIM, YOUNG K DO","ppno":"804\/968-5700","pcpadd":"STE 100 5000 COX ROAD","pcpcity":"GLEN ALLEN","pcpstate":"VA","pcpzip":23060,"pcpcounty":"","pcpid":169348,"pcpname":"","plan":"OHP - OPTIMA","program":"MEDICARE","lob":"DSNP","region":"Northern Virginia","aligned":"Y","ano":"571\/243-3743, ","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":["U07.1","I26.99","R91.8","R79.89","J18.9","K82.8","J12.89","I26.94","R09.02","M19.90","R94.5","R10.13","Z79.899","R06.02"],"date":["2020-07-06","2020-06-18","2020-07-06","2020-06-18","2020-07-06","2020-06-17","2020-06-19","2020-06-18","2020-06-18","2020-06-18","2020-06-18","2020-06-18","2020-06-18","2020-06-18"],"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":[["","13107005999","APAP\/CODEINE","TAB 300-30MG","15","Select","Select",""],["","69097096507","NABUMETONE","TAB 500MG","30","Select","Select",""],["","69097022416","ALENDRONATE","TAB 70MG","12","Select","Select",""],["","68462010430","FLUCONAZOLE","TAB 200MG","-18","Select","Select",""],["","67877019805","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","143211205","DOXYCYCL HYC","TAB 100MG","20","Select","Select",""],["","781223401","OMEPRAZOLE","CAP 40MG","90","Select","Select",""],["","781261305","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","69097042107","CELECOXIB","CAP 200MG","30","Select","Select",""],["","67877057501","BENZONATATE","CAP 200MG","20","Select","Select",""],["","62332000231","FAMOTIDINE","TAB 40MG","15","Select","Select",""],["","61314063136","NEO\/POLY\/DEX","OIN 0.1% OP","4","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","30","Select","Select",""],["","69097022416","ALENDRONATE SODIUM ","","-12","Select","Select",""],["","67877019805","AMLODIPINE BESYLATE","","90","Select","Select",""],["","71930005512","ACETAMINOPHEN\/CODEINE PHOSPHATE ","","30","Select","Select",""],["","143211205","DOXYCYCLINE HYCLATE","","20","Select","Select",""],["","13107005999","ACETAMINOPHEN\/CODEINE","","15","Select","Select",""],["","69097042107","CELECOXIB ","","30","Select","Select",""],["","70010075401","METHOCARBAMOL ","","30","Select","Select",""],["","61314063136","NEOMYCIN\/POLYMYXIN\/DEXAMETHASONE","","4","Select","Select",""],["","43547046212","DOXYCYCLINE HYCLATE DR","","30","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":[[["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Select","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":""}]}]}