{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" SAKINA NAZIR","gend":1,"add":"4099 GLENDALE ROAD","city":"WOODBRIDGE","state":"VA","zip":"22193-9998","dob":"1960-01-01","age":"","mstatus":"","insh":"2135729*02","cliId":"","pno":"703\/580-8720","cno":"703\/580-8720, 703\/580-8720, ","email":"","ename":"","eno":"","pphy":"ALEMZADEH, AMIR MD","ppno":"703\/897-4700","pcpadd":"12731 MARBLESTONE DR","pcpcity":"WOODBRIDGE","pcpstate":"VA","pcpzip":"22192-9998","pcpcounty":"","pcpid":165925,"pcpname":"","plan":"OHP - OPTIMA","program":"ACA","lob":"Small Group","region":"NORTHERN\/ WINCHESTER","aligned":"","ano":"","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":["Z71.3","E03.9","E11.65","E78.5","F41.9","R20.2","E11.9"],"date":["2020-02-27","2021-02-25","2021-02-25","2021-02-25","2020-02-27","2020-02-27","2021-02-25"],"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":[["","00002871501","HUMULIN","70\/30","20","Select","Select",""],["","00378181510","LEVOTHYROXIN","150MCG","30","Select","Select",""],["","69097094312","GABAPENTIN","300MG","30","Select","Select",""],["","68382076010","METFORMIN","1000MG","60","Select","Select",""],["","55111032201","GLIMEPIRIDE","4MG","-30","Select","Select",""],["","70710122501","AMITRIPTYLIN","10MG","30","Select","Select",""],["","70377000315","SIMVASTATIN","20MG","-30","Select","Select",""],["","31722070090","LOSARTAN","25MG","30","Select","Select",""],["","00169183711","NOVOLIN","70\/30","20","Select","Select",""],["","08290328468","INSULIN","0.5\/31G","60","Select","Select",""],["","50428031441","CVS","1000UNIT","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","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":""}]}]}