{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SUNTIKA CORTNER","gend":1,"add":"13846 JEFFERSON PARK DR APT 11","city":"HERNDON","state":"VA","zip":"20171-9998","dob":"1996-06-26","age":"","mstatus":"","insh":"2182282*01","cliId":"","pno":"702\/592-0349","cno":"702\/592-0349","email":"","ename":"","eno":"","pphy":"VENKATACHALLAM, SUNITHA MD","ppno":"703\/218-2970","pcpadd":"10340 DEMOCRACY LANE SUITE 102","pcpcity":"FAIRFAX","pcpstate":"VA","pcpzip":22030,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"703\/218-2965","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M24.575","M24.574","M19.072","M20.12","M21.612","M20.5X2","M21.6X2","R93.7","R07.89","V58.89","M25.511","M75.51","Z00.00","R79.89","K21.9","M20.42","L84.","Z76.89","M10.071","M21.611","M21.6X1","M20.5X1","M20.11","R30.0","R82.81","R10.9","Z01.818","M79.673","M19.071","Z01.812","Z20.822","Z23.","M21.619","T84.84XA","M20.41","G89.18","M79.672","S93.412A","S93.432A","S93.402A","M75.21","M77.8","J06.9","R50.9","S93.422A","S93.421A","M25.70"],"date":["2020-12-09","2021-11-19","2021-09-30","2021-02-09","2021-10-29","2021-10-29","2021-11-19","2021-09-30","2021-06-17","2022-03-22","2022-04-27","2022-04-27","2021-04-20","2021-04-20","2021-04-20","2020-02-14","2020-02-14","2020-02-14","2020-06-09","2021-10-29","2021-11-19","2021-10-29","2020-07-02","2021-06-30","2021-06-30","2021-06-30","2021-06-07","2020-02-12","2020-07-02","2021-06-07","2021-06-07","2020-01-22","2020-01-22","2021-06-10","2020-01-31","2020-03-03","2021-06-02","2021-10-07","2021-10-07","2021-10-07","2022-01-03","2022-01-03","2020-02-17","2020-02-17","2021-09-30","2021-09-30","2021-09-30"],"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":[]},{"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":[["","16571020106","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","13668009690","PANTOPRAZOLE","TAB 20MG","45","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","15","Select","Select",""],["","10702000710","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","60","Select","Select",""],["","69097081312","GABAPENTIN","CAP 100MG","21","Select","Select",""],["","68180018001","CEFADROXIL","CAP 500MG","10","Select","Select",""],["","53746020301","OXYCOD\/APAP","TAB 5-325MG","28","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":[]}},{"a":{"indx":["","1"],"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":""}]}]}