{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KELVIN   L THOMAS","gend":0,"add":"8605 TERRACE VIEW CT","city":"MANASSAS","state":"VA","zip":"20110-9998","dob":"1973-04-27","age":"","mstatus":"","insh":"20043418*01","cliId":"","pno":"571\/288-9366","cno":"571\/288-9366","email":"","ename":"","eno":"","pphy":"KIM, YOUNG DO","ppno":"703\/257-7749","pcpadd":"9303 FOREST POINT CIRCLE","pcpcity":"MANASSAS","pcpstate":"VA","pcpzip":20110,"pcpcounty":"","pcpid":105039,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","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":["I10.","N18.4","I24.8","E11.22","N18.3","E11.00","E78.5","R01.1","D64.9","R94.31","R06.02","R79.89","E11.9","I87.2","R60.9","E55.9","R53.83","N25.81","D50.0","I16.0","R60.0"],"date":["2020-05-05","2020-08-18","2020-03-05","2020-03-05","2020-02-18","2020-02-05","2020-05-05","2020-02-18","2020-02-18","2020-05-05","2020-04-24","2020-04-24","2020-03-31","2020-03-12","2020-05-05","2020-03-25","2020-02-26","2020-08-18","2020-08-18","2020-03-05","2020-03-05"],"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":[["","45963067711","METOPROL ","100MG ER","30","Select","Select",""],["","53436008401","VELTASSA ","8.4GM","30","Select","Select",""],["","64980029410","SODIUM ","10GR","60","Select","Select",""],["","50111091701","TORSEMIDE ","20MG","90","Select","Select",""],["","69452020820","CALCITRIOL ","0.5MCG","30","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","90","Select","Select",""],["","56151146004","TRUE ","GLUCOSE","50","Select","Select",""],["","53885027210","ONETOUCH ","VERIO","100","Select","Select",""],["","57599157904","FREESTYLE    TES PREC NEO","PREC NEO","100","Select","Select",""],["","31722052201","HYDRALAZINE ","100MG","90","Select","Select",""],["","00088221905","LANTUS ","100\/ML","3","Select","Select",""],["","13668010401","ISOSORB ","30MG ER","90","Select","Select",""],["","65862014505","CARVEDILOL ","25MG","60","Select","Select",""],["","50458057930","XARELTO ","20MG","30","Select","Select",""],["","65862020199","LOSARTAN ","25MG","90","Select","Select",""],["","00002771559","BASAGLAR ","100UNIT","9","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","12","Select","Select",""],["","50111091701","TORSEMIDE","20MG","30","Select","Select",""],["","64980029410","SODIUM","10GR","180","Select","Select",""],["","45963067711","METOPROL","100MG ER","90","Select","Select",""],["","69452020820","CALCITRIOL","0.5MCG","30","Select","Select",""],["","68180072003","AMLODIPINE","5MG","90","Select","Select",""],["","00088221905","LANTUS","100\/ML","3","Select","Select",""],["","31722052101","HYDRALAZINE","50MG","90","Select","Select",""],["","53436008401","VELTASSA","8.4GM","30","Select","Select",""],["","65862014505","CARVEDILOL","25MG","60","Select","Select",""],["","53885024450","ONETOUCH","ULTRA BL","100","Select","Select",""],["","56151146004","TRUE","GLUCOSE","50","Select","Select",""],["","57599157904","FREESTYLE TES PREC NEO","PREC NEO","100","Select","Select",""],["","13668010401","ISOSORB","30MG ER","30","Select","Select",""],["","50458057930","XARELTO","20MG","30","Select","Select",""],["","00002771559","BASAGLAR","100UNIT","9","Select","Select",""],["","69452015120","VITAMIN","50000UNT","12","Select","Select",""],["","65862020199","LOSARTAN","25MG","90","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","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}