{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANA   L FLORES","gend":1,"add":"14303 WATERY MOUNTAIN CT","city":"CENTREVILLE","state":"VA","zip":"20120-9998","dob":"1949-06-21","age":"","mstatus":"","insh":"900044084*01","cliId":"1AJ1QG8YV02","pno":"703\/472-1736","cno":"703\/472-1736","email":"","ename":"","eno":"","pphy":"MARKIN, LAURIE S MD","ppno":"703\/266-2442","pcpadd":"5645 STONE RD","pcpcity":"CENTREVILLE","pcpstate":"VA","pcpzip":20120,"pcpcounty":"","pcpid":119804,"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\/266-7158","pcpnpi":""},{"a":{"indx":["","","","","","1","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z12.31","M81.0","S62.101A","S62.102A","R42.","W19.XXXA","Z86.73","R55.","R94.31","S62.90XA","I63.9","S52.91XA","S52.92XA","I10.","S62.102D","S62.90XD","R26.81","M25.531","M25.532","S52.591A","S52.592A","Z91.81","R26.9","S52.571A","M62.84","R27.0","Z71.89","Z79.899","S52.572A","S52.501A","S01.81XA","E86.0","E78.5","M85.80","S52.572S","R29.898","S62.92XD","S62.91XD","S62.101D","R53.81","W01.0XXA","S52.502A","I95.89","S52.512A","I15.9","W19.XXXD","S52.502D","S52.501D","M15.0","G47.30","Z79.82"],"date":["2021-05-14","2021-09-17","2021-09-02","2021-09-02","2021-09-17","2021-09-02","2021-09-17","2021-10-19","2021-08-27","2021-08-27","2021-08-28","2021-08-28","2021-08-28","2021-09-20","2021-09-17","2021-09-17","2021-09-17","2021-11-16","2021-11-16","2021-10-19","2021-11-02","2021-09-17","2021-10-19","2021-08-26","2021-09-04","2021-09-04","2021-09-04","2021-09-04","2021-09-17","2021-10-19","2021-08-26","2021-09-20","2021-09-20","2021-09-20","2021-10-19","2021-09-13","2021-09-13","2021-09-13","2021-09-15","2021-09-15","2021-08-26","2021-09-17","2021-09-14","2021-09-17","2021-09-04","2021-09-20","2021-09-20","2021-09-20","2021-09-20","2021-09-20","2021-09-20"],"priorHcc":["",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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":[["","24979003801","METOPROL SUC","TAB 50MG ER","90","Select","Select",""],["","67877019805","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","60505257808","ATORVASTATIN","TAB 10MG","30","Select","Select",""],["","24979003801","METOPROLOL SUCCINATE ER","","90","Select","Select",""],["","67877019805","AMLODIPINE BESYLATE","","90","Select","Select",""],["","60505257808","ATORVASTATIN CALCIUM ","","30","Select","Select",""],["","69097022416","ALENDRONATE SODIUM ","","12","Select","Select",""],["","60505257808","ATORVASTATIN CALCIUM","","30","Select","Select",""],["","69097022416","ALENDRONATE SODIUM","","12","Select","Select",""],["","10702001801","OXYCODONE HYDROCHLORIDE","5MG","-21","Select","Select",""],["","67877019805","AMLODIPINE BESYLATE                                                   ","TAB 5MG","90","Select","Select",""],["","24979003801","METOPROLOL SUCCINATE ER                                               ","TAB 50MG ER","90","Select","Select",""],["","60505257808","ATORVASTATIN CALCIUM                                                  ","TAB 10MG","30","Select","Select",""],["","69097022416","ALENDRONATE SODIUM                                                    ","TAB 70MG","12","Select","Select",""],["","10702001801","OXYCODONE HYDROCHLORIDE                                               ","TAB 5MG","21","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":""}]}]}