{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LINH TRAN","gend":1,"add":"44513 POTTER TERRACE","city":"ASHBURN","state":"VA","zip":"20147-9998","dob":"1979-08-21","age":"","mstatus":"","insh":"2268334*01","cliId":"","pno":"571\/991-1654","cno":"571\/991-1654","email":"","ename":"","eno":"","pphy":"ACEVEDO SANTANA, YLIANA MD","ppno":"571\/252-7353","pcpadd":"43300 SO WALK PLAZA STE 200","pcpcity":"ASHBURN","pcpstate":"VA","pcpzip":20148,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"571\/223-1797","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R09.02","J18.9","R73.9","Z20.828","R50.81","J96.01","B99.9","A41.89","U07.1","J12.89","E86.0","E78.5","E78.1","L30.9","B35.9","J06.9","R94.5","M67.431"],"date":["2020-05-17","2020-05-26","2020-05-17","2021-01-05","2020-05-20","2020-05-20","2020-05-20","2020-05-17","2020-05-26","2020-05-18","2020-05-17","2020-05-18","2020-05-17","2021-07-21","2021-07-21","2020-05-18","2020-05-18","2022-09-20"],"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":[["","62756014202","METFORMIN","TAB 500MG ER","90","Select","Select",""],["","64380073706","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","53885044801","ONETOUCH","KIT ULTRA 2","1","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","59762444002","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00093321930","KETOCONAZOLE","CRE 0.02","30","Select","Select",""],["","65702073110","ACCU-CHECK","KIT GUIDE ME","1","Select","Select",""],["","68180030360","CEFUROXIME","TAB 500MG","14","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":""}]}]}