{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SURINDER   S RAHEJA","gend":0,"add":"10700 ELIES CT","city":"FAIRFAX STATION","state":"VA","zip":"22039-9998","dob":"1949-04-15","age":"","mstatus":"","insh":"900044459*01","cliId":"5JC5F80NG84","pno":"703\/629-6724","cno":"703\/629-6724","email":"","ename":"","eno":"","pphy":"THOMAS, DENNIS L MD","ppno":"804\/932-4388","pcpadd":"1850 POCAHONTAS TRAIL","pcpcity":"QUINTON","pcpstate":"VA","pcpzip":23141,"pcpcounty":"","pcpid":671676,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/932-9860","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z96.651","M25.561","M25.661","R26.2","I10.","R05.","E55.9","M17.11","I11.9","R42.","R53.83","E78.00","D51.9","R21.","E78.5","R55.","R94.118","R60.9","L73.9","Z12.11","M79.89","I87.2","R60.0","M79.604","R22.41","I83.891"],"date":["2021-04-28","2021-08-16","2021-04-28","2021-04-28","2021-08-27","2021-02-11","2021-02-11","2021-03-29","2021-10-20","2021-05-25","2021-01-20","2021-05-26","2021-02-03","2021-06-18","2021-10-20","2021-06-07","2021-06-07","2021-08-16","2021-08-16","2021-05-23","2021-08-18","2021-08-27","2021-08-18","2021-08-18","2021-08-27","2021-11-09"],"priorHcc":["",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":[["","68645056259","IBUPROFEN ","600MG","30","Select","Select",""],["","65162019011","NAPROXEN ","500MG","60","Select","Select",""],["","00093505998","ATORVASTATIN ","20MG","90","Select","Select",""],["","68645051554","AMLODIPINE ","5MG","90","Select","Select",""],["","16571020150","DICLOFENAC ","75MG DR","60","Select","Select",""],["","00781261305","AMOXICILLIN ","500MG","4","Select","Select",""],["","00713063415","MOMETASONE ","0.10%","-60","Select","Select",""],["","68462029817","CLOTRIM\/BETA ","DIPROP","60","Select","Select",""],["","67877021905","CEPHALEXIN ","500MG","30","Select","Select",""],["","68645051554","","5MG","90","Select","Select",""],["","65162019011","NAPROXEN","500MG","60","Select","Select",""],["","16571020150","DICLOFENAC","75MG DR","60","Select","Select",""],["","68645056259","IBUPROFEN","600MG","30","Select","Select",""],["","68645051554","AMLODIPINE","5MG","90","Select","Select",""],["","00781261305","AMOXICILLIN","500MG","4","Select","Select",""],["","00093505998","ATORVASTATIN","20MG","90","Select","Select",""],["","00713063415","MOMETASONE","0.10%","60","Select","Select",""],["","68462029817","CLOTRIM\/BETA","DIPROP","60","Select","Select",""],["","67877021905","CEPHALEXIN","500MG","30","Select","Select",""],["","65862006299","METOPROL","25MG","180","Select","Select",""],["","65862006299","METOPROL ","TAB 25MG","180","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":""}]}]}