{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"S DERAJNOSDUH ","gend":0,"add":"IVRES ERAC YTILAUQ SIRRAH                      SEC","city":"GLEN ALLEN               ","state":"VA","zip":"23060-2135","dob":"1989-02-15","age":"","mstatus":"","insh":"00112544","cliId":"","pno":"7604590676","cno":5409045098,"email":"","ename":"","eno":"","pphy":"MASOOD, FARAZ","ppno":8045263821,"pcpadd":"16021 KAIROS RD STE A,","pcpcity":"South Chesterfield","pcpstate":"VA","pcpzip":238345208,"pcpcounty":"","pcpid":"","pcpname":"FARAZ MASOOD PLLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"2912   ALLEN'S CROSSING                           ","add3":"","madd1":"HARRIS QUALITY CARE SERVICES                      ","madd2":"2912   ALLEN'S CROSSING                           ","madd3":"","mcity":"GLEN ALLEN               ","mstate":"VA","mzip":"23060-2135","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","R81","R25.1","E78.5","F25.0","E11.65","R80.9","Z79.4","F71","E11.8","Z09","Z86.59","F79","F25.9","F12.90","F17.200","R45.850","Z79.84","Z88.0","F91.9","E87.8","M54.9","R63.2","K59.00","E83.51","R19.7","I10","Z87.891","Z83.3","R68.89","R73.9","Z00.00","F20.9","Z23","Z11.1","R10.9","F70","Z79.899","Z20.822","F20.89","Z79.82","F63.9","K08.89","R53.1","E55.9","E83.42","E20.9","I95.1","R00.0","Z91.14","F72","F43.24","E10.65","U07.1","R45.851","Z79.891","Z79.52","R45.4","F51.5","R05","R50.9","Z13.220","R79.89","Z03.818","S61.401A","R11.2","R30.0","R46.2","Z59.0","F06.8","Z74.3","E86.0","I95.9","R55","R42","R23.4","L85.9","L60.3","E87.1","E87.70","R63.1","J96.01","R40.0","R40.1","E87.2","R74.0","Z11.59","J15.8","B96.89","J69.0","G93.41","E22.2","E87.3","F20.2","Z20.828","J91.8","D72.819","D64.9","E87.6","J96.00","Z99.11","J98.4","Z46.82","R40.20","R06.9","R11.10","G93.40","R35.8","J18.9","R06.02","R41.82","R79.81","R94.31","T17.908A","G93.89","I61.9","R41.0","Z45.2","R91.8","J81.1","R09.89","F31.9","R94.01","Z91.5","R90.89","R09.02","G93.9","R62.50","A41.9","R65.21","I80.9","F41.9","F20.1","F06.1","Z87.19","R56.9","L29.9","R21","R23.8","Z02.9","Z56.0","E10.10","E86.1","F43.25","F63.81","R47.81","R44.0","R44.1","Z00.8","R44.3","F51.01","E78.00","L30.9","J01.90","R05.9","M20.21","M20.22"," ","J98.11"],"date":["2022-08-02","2020-01-02","2020-01-01","2021-03-19","2022-10-07","2022-06-09","2020-01-02","2022-06-09","2022-10-07","2020-12-31","2020-01-15","2020-08-07","2021-07-03","2021-05-25","2020-01-22","2021-05-22","2021-05-25","2021-10-07","2021-05-22","2021-10-07","2020-02-06","2019-02-05","2020-03-05","2020-12-31","2020-03-05","2021-02-06","2022-05-02","2021-09-03","2021-02-06","2021-02-06","2021-10-07","2022-02-09","2022-02-09","2022-02-07","2022-02-09","2020-02-11","2020-08-25","2022-05-02","2022-06-13","2021-02-18","2021-09-03","2021-02-18","2020-03-04","2020-03-04","2020-12-31","2020-07-26","2020-03-05","2020-07-30","2022-11-08","2021-06-14","2021-03-25","2021-03-28","2019-04-20","2021-05-25","2021-05-25","2021-05-22","2021-05-22","2021-05-25","2020-06-02","2020-06-02","2020-06-02","2020-06-05","2020-12-31","2021-06-10","2019-06-12","2021-06-14","2021-06-14","2021-06-22","2021-07-04","2021-07-03","2021-07-03","2019-07-24","2019-07-24","2020-07-31","2019-07-24","2020-07-24","2020-07-24","2020-07-24","2020-09-08","2020-07-26","2020-07-26","2020-08-16","2020-07-26","2020-07-26","2020-07-26","2020-07-26","2020-07-26","2020-07-26","2020-07-26","2020-08-16","2020-08-16","2020-08-16","2020-08-16","2020-08-16","2020-08-16","2020-08-16","2020-08-04","2020-08-06","2020-07-26","2020-08-01","2020-08-06","2020-07-27","2020-08-05","2020-07-26","2020-07-26","2021-09-08","2020-08-25","2020-08-07","2020-08-03","2020-07-27","2020-07-30","2020-07-27","2020-08-02","2020-07-31","2020-08-15","2020-08-06","2020-08-14","2020-07-30","2020-08-05","2020-08-01","2020-08-01","2020-08-09","2020-08-02","2020-08-06","2020-08-25","2020-08-07","2020-08-14","2020-08-06","2020-08-07","2020-08-07","2020-08-08","2020-08-08","2020-08-10","2020-08-16","2020-08-16","2020-08-25","2020-09-16","2020-09-16","2020-09-16","2021-10-07","2021-10-07","2018-10-21","2018-10-21","2018-10-21","2018-10-21","2018-11-26","2020-12-08","2020-12-07","2020-12-08","2020-12-08","2020-12-31","2020-12-31","2020-12-31","2022-06-20","2022-06-20","2022-06-09","2022-06-09","2022-11-08","2022-11-08"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"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":[["","68180051201","LISINOPRIL","TAB 2.5MG","90","Select","Select",""],["","57664050083","MIRTAZAPINE","TAB 30MG","30","Select","Select",""],["","14539067401","HYDROXYZ","CAP 25MG","12","Select","Select",""],["","16714087603","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","62756014202","METFORMIN","TAB 500MG ER","120","Select","Select",""],["","69238105801","CHLORPROMAZ","TAB 50MG","90","Select","Select",""],["","60505014201","GLIPIZIDE","TAB 10MG","28","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","10","Select","Select",""],["","29300014005","DIVALPROEX","TAB 500MG DR","124","Select","Select",""],["","00121067516","VALPROIC","SOL 250\/5ML","280","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","TES LITE","300","Select","Select",""],["","16729000201","GLIMEPIRIDE","TAB 2MG","30","Select","Select",""],["","00088222033","LANTUS","INJ 100\/ML","10","Select","Select",""],["","08496300601","EASY","MIS LANC\/30G","50","Select","Select",""],["","13107008305","LORAZEPAM","TAB 0.5MG","23","Select","Select",""],["","00904666661","GABAPENTIN","CAP 300MG","1","Select","Select",""],["","08214084021","UNIFINE","MIS 32GX4MM","60.00","Select","Select",""],["","56151146004","TRUE","TES GLUCOSE","50","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","200","Select","Select",""],["","00536110301","ALCOHOL","PAD 0.7","100","Select","Select",""],["","65702071110","ACCU-CHEK","TES GUIDE","50","Select","Select",""],["","08222094193","INSULIN","MIS 1ML\/31G","100","Select","Select",""],["","08222440006","ULTICARE","PAD ALCOHOL","200","Select","Select",""],["","69097083512","SERTRALINE","TAB 100MG","90","Select","Select",""],["","69097012403","TOPIRAMATE","TAB 100MG","21","Select","Select",""],["","49348089610","SM","PAD PREP","100","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","90","Select","Select",""],["","08290326895","BD","PAD SNGL USE","100","Select","Select",""],["","08080681800","WEBCOL","PAD MEDIUM","100","Select","Select",""],["","00168000615","TRIAMCINOLON","OIN 0.001","15","Select","Select",""],["","00093010901","CARBAMAZEPIN","TAB 200MG","90","Select","Select",""],["","53746016960","MEMANTINE","TAB HCL 10MG","60","Select","Select",""],["","67877031901","IBUPROFEN","TAB 400MG","15","Select","Select",""],["","21922002107","PERMETHRIN","CRE 0.05","60","Select","Select",""],["","94046000118","ADVOCATE","MIS LANCETS","50","Select","Select",""],["","00169643810","LEVEMIR","INJ FLEXTOUC","12","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","21","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","08290320119","BD  PEN NEEDL","MIS 31GX5MM","100","Select","Select",""],["","99073071231","FREESTYLE    TES INSULINX","TES INSULINX","150","Select","Select",""],["","99073070805","FREESTYLE    MIS LITE","MIS LITE","1","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":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","",""],[""],[""],[""],[""]],"comment":[["","",""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"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":""}]}]}