{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KAWSAR HUSSEIN","gend":1,"add":"43627 PREDDY CTS","city":"ASHBURN","state":"VA","zip":20148,"dob":"1941-01-10","age":"","mstatus":"","insh":"20067355*01","cliId":"","pno":"703\/474-4719","cno":"703\/474-4719","email":"","ename":"","eno":"","pphy":"ACEVEDO SANTANA, YLIANA MD","ppno":"571\/252-7353","pcpadd":"SUITE 200 43300 SO WALK PLAZA","pcpcity":"ASHBURN","pcpstate":"VA","pcpzip":20148,"pcpcounty":"","pcpid":114569,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"571\/223-1797","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K21.9","R19.7","K75.4","K74.60","N18.3","I89.0","I10.","R60.9","E83.40","R05.","NO DATA","E87.2"],"date":["2020-12-14","2020-12-14","2020-09-18","2021-09-21","2020-09-21","2020-09-18","2020-09-21","2021-09-21","2020-09-21","2020-09-21","2021-09-21","2021-09-21"],"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":[["","60219107601","AZATHIOPRINE ","50MG","45","Select","Select",""],["","00527293137","PREDNISONE ","2.5MG","90","Select","Select",""],["","62175061743","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","69315011710","FUROSEMIDE ","40MG","30","Select","Select",""],["","64380071306","BENZONATATE ","200MG","30","Select","Select",""],["","65862085999","FAMOTIDINE ","20MG","60","Select","Select",""],["","60219107601","AZATHIOPRINE","50MG","45","Select","Select",""],["","64380071306","BENZONATATE","200MG","30","Select","Select",""],["","69315011710","FUROSEMIDE","40MG","30","Select","Select",""],["","00527293137","PREDNISONE","2.5MG","90","Select","Select",""],["","62175061743","PANTOPRAZOLE","40MG","30","Select","Select",""],["","65862086001","FAMOTIDINE","40MG","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":[[["No","Select","","","","","Select","",""],["No","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":""}]}]}