{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOEL JOHNSON","gend":0,"add":"4396 ENSBROOK LN","city":"WOODBRIDGE","state":"VA","zip":"22193-9998","dob":"1983-09-01","age":"","mstatus":"","insh":"2290203*01","cliId":"","pno":"240\/492-9418","cno":"240\/492-9418","email":"","ename":"","eno":"","pphy":"QURESHI, SHABANA MD","ppno":"571\/659-9387","pcpadd":"5808 MAPLEDALE PLAZA","pcpcity":"DALE CITY","pcpstate":"VA","pcpzip":22193,"pcpcounty":"","pcpid":175024,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"571\/659-9387","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","E11.65","E78.2","Z86.39","E11.649","R56.9","R55.","F19.90","R73.9","Z03.818","Z71.3","Z71.82"],"date":["2020-05-09","2020-07-15","2020-07-15","2020-07-15","2020-07-15","2020-11-26","2020-11-26","2020-11-26","2020-04-21","2020-06-19","2020-06-08","2020-06-08"],"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":[["","68382075810","METFORMIN ","500MG","60","Select","Select",""],["","00597015230","JARDIANCE ","10MG","30","Select","Select",""],["","53885024510","ONETOUCH ","ULTRA","200","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","12","Select","Select",""],["","00006011231","JANUVIA ","50MG","30","Select","Select",""],["","56151146004","TRUE ","GLUCOSE","50","Select","Select",""],["","70377002811","ATORVASTATIN ","20MG","30","Select","Select",""],["","38396030176","CVS ","THIN 26G","100","Select","Select",""],["","55111032101","GLIMEPIRIDE ","2MG","60","Select","Select",""],["","38396030176","CVS","THIN 26G","100","Select","Select",""],["","68382075810","METFORMIN","500MG","60","Select","Select",""],["","53885044801","ONETOUCH","ULTRA 2","1","Select","Select",""],["","56151147002","TRUE","METER","1","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","12","Select","Select",""],["","00597015230","JARDIANCE","10MG","30","Select","Select",""],["","55111032101","GLIMEPIRIDE","2MG","180","Select","Select",""],["","00006011231","JANUVIA","50MG","30","Select","Select",""],["","70377002811","ATORVASTATIN","20MG","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","",""],["N\/A","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":""}]}]}