{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CLAYTON DUNSTON","gend":0,"add":"5673 DERBY CT APT 220","city":"ALEXANDRIA","state":"VA","zip":"22311-9998","dob":"1963-10-14","age":"","mstatus":"","insh":"20043888*01","cliId":"","pno":5717995715,"cno":5717995715,"email":"","ename":"","eno":"","pphy":"NGO, MINH VAN MD","ppno":7037764001,"pcpadd":"3300 GALLOWS ROAD,","pcpcity":"FALLS CHURCH","pcpstate":"VA","pcpzip":"22042-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7037767113,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F12.20","F10.20","F14.10","I48.92","T82.198A","I48.0","Z86.79","I42.8","I10.","E83.42","I48.91","Z95.810","R00.2","Z74.3","I49.9","I42.9","T82.897A","F17.203","R07.9","S59.901A","Z20.822","R00.0","F17.210","R09.89","R77.8","I82.611","R07.89","D72.829","F12.90","T75.89XA"],"date":["2021-06-10","2021-06-10","2021-06-10","2021-11-03","2022-01-01","2022-01-02","2021-08-10","2022-01-26","2022-02-27","2021-08-09","2022-01-02","2022-02-15","2022-02-15","2022-02-27","2021-08-09","2022-01-01","2022-01-01","2022-01-29","2022-01-01","2022-01-03","2022-01-01","2022-01-29","2022-02-27","2022-02-27","2022-01-01","2022-01-03","2022-02-15","2021-08-10","2021-08-10","2022-02-27"],"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":[["","00003089421","ELIQUIS","5 MG","60","Select","Select",""],["","76385011250","CARVEDILOL","12.5 MG","180","Select","Select",""],["","68180098003","LISINOPRIL","10 MG","90","Select","Select",""],["","65862073260","AMIODARONE","TAB 200MG","30","Select","Select",""],["","00245014430","PACERONE","TAB 100MG","30","Select","Select",""],["","51862024160","AMIODARONE HCL","200 MG","90","Select","Select",""],["","51862024160","AMIODARONE TAB","200MG","30","Select","Select",""],["","00003089421","ELIQUIS TAB","5MG","60","Select","Select",""],["","68180098003","LISINOPRIL TAB","10MG","90","Select","Select",""],["","76385011250","CARVEDILOL TAB","12.5MG","180","Select","Select",""],["","00245014430","PACERONE TAB","100MG","30","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":""}]}]}