{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RUKHSANA BEGUM","gend":1,"add":"5600 ELEANOR CT APT 202","city":"ALEXANDRIA","state":"VA","zip":22303,"dob":"1954-12-06","age":"","mstatus":"","insh":"20063963*01","cliId":"","pno":"571\/758-9148","cno":"","email":"","ename":"","eno":"","pphy":"Route,  barbara","ppno":"703\/535-5568","pcpadd":"5424 Discovery Park Blvd BLDB A STE 201","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":22303,"pcpcounty":"","pcpid":"","pcpname":"NEIGHBORHOOD HEALTH","plan":"OHP","program":"Medicaid","lob":"OHCC","region":"NORTHERN\/ WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"703\/751-1003","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R94.31","I10.","I51.7","Z12.31","Z12.11","E11.9","R00.0","M25.561","M25.562","M17.0","G89.29","NO DATA","E78.00","R01.1"],"date":["2022-10-28","2022-11-18","2021-10-01","2021-10-15","2021-10-01","2022-05-24","2021-10-15","2022-06-22","2022-06-22","2022-06-23","2021-03-31","2022-01-25","2022-10-28","2022-10-28"],"priorHcc":["","","","","","","","","","","","","",""]}}]},{"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":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","68645051054","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","68382005005","MELOXICAM","TAB 7.5MG","30","Select","Select",""],["","68645051554","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","00093505698","ATORVASTATIN","TAB 10MG","90","Select","Select",""],["","68645058259","METFORMIN","TAB 500MG","180","Select","Select",""],["","68645059354","LISINOPRIL","TAB 40MG","30","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","50742061510","METOPROL","TAB 25MG ER","30","Select","Select",""],["","29300041519","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","68382009405","CARVEDILOL","TAB 12.5MG","60","Select","Select",""],["","53885000810","ONETOUCH","MIS PLUS 33G","200","Select","Select",""],["","53885004401","ONE","KIT VERIO FL","1","Select","Select",""],["","21292000619","TRUE","TES GLUCOSE","200","Select","Select",""],["","00067815203","VOLTAREN","GEL 0.01","100","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}