{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"INESSA ROSS","gend":1,"add":"C\/O ANNA ROSS 6710 VAN FLEET DR","city":"MCLEAN","state":"VA","zip":"22101-9998","dob":"1931-11-17","age":"","mstatus":"","insh":"900042479*01","cliId":"2JW7P20PX64","pno":"703\/288-1897","cno":"703\/288-1897","email":"","ename":"","eno":"","pphy":"ZAMSKAYA, ANNA MD","ppno":"703\/848-8500","pcpadd":"6645 ELM STREET SUITE 710","pcpcity":"MCLEAN","pcpstate":"VA","pcpzip":22101,"pcpcounty":"","pcpid":199476,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"703\/893-1946","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E78.5","Z79.899","I25.10","I63.9","E11.9","E03.9","R35.0","R32.","J30.2","E55.9","E66.3","R63.3","I69.391","I25.9","Z86.73","I21.A9","R05.","E78.2","I10.","I11.9","R94.31","R91.8","I63.512","E78.00"],"date":["2021-11-22","2021-11-22","2021-11-22","2021-11-22","2021-05-28","2021-08-13","2021-07-26","2021-01-22","2021-03-09","2021-05-28","2021-08-13","2021-09-15","2021-10-15","2021-07-20","2021-07-20","2021-07-20","2021-08-12","2021-07-20","2021-07-20","2021-09-02","2021-09-02","2021-08-12","2021-08-23","2021-08-23"],"priorHcc":[null,null,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":[["","65862057490","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","65862035790","CLOPIDOGREL","TAB 75MG","90","Select","Select",""],["","69238115409","EZETIMIBE","TAB 10MG","-90","Select","Select",""],["","13668042990","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","68382025216","ATORVASTATIN","TAB 80MG","90","Select","Select",""],["","378180010","LEVOTHYROXIN","TAB 25MCG","90","Select","Select",""],["","469260230","MYRBETRIQ","TAB 50MG","90","Select","Select",""],["","68382075810","METFORMIN","TAB 500MG","180","Select","Select",""],["","57664050658","METOPROL TAR","TAB 25MG","180","Select","Select",""],["","16729017017","ESCITALOPRAM","TAB 20MG","90","Select","Select",""],["","16729017017","ESCITALOPRAM OXALATE ","","90","Select","Select",""],["","469260230","MYRBETRIQ ","","30","Select","Select",""],["","13668042990","PANTOPRAZOLE SODIUM","","90","Select","Select",""],["","57664050658","METOPROLOL TARTRATE","","180","Select","Select",""],["","68382025216","ATORVASTATIN CALCIUM ","","90","Select","Select",""],["","378180010","LEVOTHYROXINE SODIUM ","","90","Select","Select",""],["","69238115409","EZETIMIBE ","","90","Select","Select",""],["","65862057490","MONTELUKAST SODIUM ","","30","Select","Select",""],["","68382075810","METFORMIN HYDROCHLORIDE","","180","Select","Select",""],["","00378180010","LEVOTHYROXINE SODIUM","","90","Select","Select",""],["","16729017017","ESCITALOPRAM OXALATE","","90","Select","Select",""],["","68382025216","ATORVASTATIN CALCIUM","","90","Select","Select",""],["","65862057490","MONTELUKAST SODIUM","","30","Select","Select",""],["","69238115409","EZETIMIBE                                                             ","TAB 10MG","-90","Select","Select",""],["","00469260230","MYRBETRIQ                                                             ","TAB 50MG","30","Select","Select",""],["","57664050658","METOPROLOL TARTRATE                                                   ","TAB 25MG","180","Select","Select",""],["","13668042990","PANTOPRAZOLE SODIUM                                                   ","TAB 40MG","90","Select","Select",""],["","65862035790","CLOPIDOGREL                                                           ","TAB 75MG","90","Select","Select",""],["","16729017017","ESCITALOPRAM OXALATE                                                  ","TAB 20MG","90","Select","Select",""],["","00378180010","LEVOTHYROXINE SODIUM                                                  ","TAB 25MCG","90","Select","Select",""],["","65862057490","MONTELUKAST SODIUM                                                    ","TAB 10MG","30","Select","Select",""],["","68382025216","ATORVASTATIN CALCIUM                                                  ","TAB 80MG","90","Select","Select",""],["","68382075810","METFORMIN HYDROCHLORIDE                                               ","TAB 500MG","180","Select","Select",""],["","49281012165","FLUZONE HIGH-DOSE PF 2021-2022                                        ","INJ 2021-22","1","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":""}]}]}