{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MAHABUB   M CHOWDHURY","gend":0,"add":"104 OAK ROAD","city":"STAFFORD","state":"VA","zip":"22556-9998","dob":"1979-04-12","age":"","mstatus":"","insh":"900047197*01","cliId":"9QF8UT9HU47","pno":"540\/720-1233","cno":"540\/720-1233","email":"","ename":"","eno":"","pphy":"REID, YOLANDA G MD","ppno":"540\/659-2111","pcpadd":"STE 123 95 DUNN DR","pcpcity":"STAFFORD","pcpstate":"VA","pcpzip":22556,"pcpcounty":"","pcpid":207525,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"Non-DSNP","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":["E11.9","E78.5","Z22.7","G25.1","F25.8","Z79.899"],"date":["2021-05-11","2021-05-11","2021-05-11","2021-05-07","2021-05-07","2021-10-19"],"priorHcc":["","","","","",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":[["","69097012303","TOPIRAMATE","TAB 50MG","90","Select","Select",""],["","65862059501","DIVALPROEX","TAB 500MG ER","270","Select","Select",""],["","43975035203","PALIPERIDONE","TAB ER 9MG","-30","Select","Select",""],["","50458056401","INVEGA SUST","INJ 234\/1.5","2","Select","Select",""],["","43975035203","PALIPERIDONE ER ","","-30","Select","Select",""],["","50458056401","INVEGA SUSTENNA ","","2","Select","Select",""],["","65862059501","DIVALPROEX SODIUM ER ","","270","Select","Select",""],["","65862059501","DIVALPROEX SODIUM ER","","270","Select","Select",""],["","43975035203","PALIPERIDONE ER","","30","Select","Select",""],["","50458056401","INVEGA SUSTENNA","","2","Select","Select",""],["","16729008110","NALTREXONE HCL","","90","Select","Select",""],["","49281042150","FLUZONE QUADRIVALENT 2021-2022","2021-22","0","Select","Select",""],["","43975035203","PALIPERIDONE ER                                                       ","TAB ER 9MG","30","Select","Select",""],["","50458056401","INVEGA SUSTENNA                                                       ","INJ 234\/1.5","2","Select","Select",""],["","69097012303","TOPIRAMATE                                                            ","TAB 50MG","90","Select","Select",""],["","65862059501","DIVALPROEX SODIUM ER                                                  ","TAB 500MG ER","270","Select","Select",""],["","16729008110","NALTREXONE HCL                                                        ","TAB 50MG","90","Select","Select",""],["","80777027310","MODERNA COVID-19 VACCINE                                              ","INJ COVID-19","0","Select","Select",""],["","49281042150","FLUZONE QUADRIVALENT 2021-2022                                        ","INJ 2021-22","0","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":""}]}]}