{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" NORAFSIRROM","gend":0,"add":"            TS ELPAM 7082                         ","city":"HOPEWELL                 ","state":"VA","zip":"23860-9998","dob":"1961-07-30","age":"","mstatus":"","insh":"00115731","cliId":"","pno":"2340823664","cno":8043246623,"email":"","ename":"","eno":"","pphy":"MOHIUDDIN, ABDUL","ppno":8044588583,"pcpadd":"1012 WINSTON CHURCHILL DR,","pcpcity":"Hopewell","pcpstate":"VA","pcpzip":238605141,"pcpcounty":"","pcpid":"","pcpname":"TWIN RIVERS MEDICAL CLINIC PC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"2807 MAPLE ST                                     ","madd2":"                                                  ","madd3":"","mcity":"HOPEWELL                 ","mstate":"VA","mzip":"23860-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K85.90","B19.20","F10.20","I10","E78.5","K85.9","K85.20","E87.6","R74.0","K29.70","K29.80","R55","Z86.73","Z23","R10.13","Y90.0","K86.89","F10.10","S62.355A","S62.357A","B18.2","Z86.2","Z11.52","R51.9","K74.60","R73.09","R73.03","R10.9","F17.210","K85.80","K56.7","R10.84","K86.3","M54.9","S62.355D","S62.357D","Z68.23","Z87.19","K86.1","F19.10","Z88.0","R11.2","E87.1","E78.00","E86.0","R94.31","K86.2","R93.3","K83.8","R93.5","I25.10","I69.90","K74.00","R00.0","Z71.89","Z71.3","E83.52","Z09","K08.89","S62.335A","S62.337A","W22.09XA","Z79.899","M79.641","E55.9","Z13.220","Z13.29","Z83.3","K74.02","K70.30","Z20.5","Z72.89","Z11.59","Z12.11","F52.21","S62.316A","W22.8XXA","R18.8","D73.5","K57.30","Z91.19","S62.339A","M25.532","M79.642","M79.89","W22.01XA","B97.29","K86.0","Z79.82","M25.552","M25.572","K86.9","M79.605","R53.1","R20.9","K35.890","K76.89","R42","F14.90","F17.200","R94.5","R35.0","I63.81","I63.9","G81.91","Z20.822","I65.29","R29.705","Z82.49","Z87.891","N40.0"," ","R93.2","R41.82","R26.81","R91.8","R00.1","I63.40","I48.91","R29.704","F12.10","F14.10","Z79.02","M62.81","R26.89","M79.604","K80.20","I63.432"],"date":["2022-11-14","2022-09-20","2022-09-20","2022-12-05","2022-11-14","2019-05-01","2018-12-07","2020-02-23","2018-12-06","2019-07-12","2019-07-12","2022-09-20","2022-10-05","2022-09-20","2021-01-16","2021-01-16","2022-11-15","2021-01-16","2021-06-08","2021-06-08","2021-10-28","2021-10-13","2021-09-03","2022-09-19","2021-10-28","2021-11-10","2020-08-24","2021-01-19","2022-11-14","2018-12-06","2018-12-06","2020-02-24","2022-11-14","2019-10-14","2021-07-22","2021-07-22","2021-06-14","2021-06-08","2020-02-24","2020-02-24","2022-11-14","2020-02-24","2019-10-09","2020-02-23","2022-09-19","2022-09-19","2020-02-23","2020-02-23","2020-02-23","2020-02-23","2020-02-23","2021-10-13","2021-04-29","2022-07-25","2022-07-25","2022-07-25","2022-07-25","2021-02-24","2021-04-16","2021-06-17","2021-06-17","2021-06-17","2021-06-08","2018-02-23","2022-09-20","2022-09-20","2022-09-20","2022-09-20","2021-10-28","2019-07-12","2019-06-24","2019-06-24","2021-10-28","2020-07-27","2021-01-29","2021-06-08","2021-06-08","2019-10-09","2019-10-09","2022-11-15","2021-10-13","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2020-09-24","2019-04-30","2022-11-14","2018-08-07","2018-08-07","2021-01-16","2018-08-07","2022-11-15","2018-08-07","2019-10-09","2019-07-12","2022-09-19","2022-09-19","2022-09-19","2021-01-19","2021-02-24","2022-11-11","2022-12-05","2022-10-05","2022-11-14","2022-10-05","2022-10-05","2022-11-14","2022-10-05","2022-10-17","2022-12-05","2022-11-15","2022-11-15","2022-11-15","2022-11-15","2022-11-15","2022-11-14","2022-11-14","2022-11-14","2022-11-14","2022-11-14","2022-11-14","2022-11-11","2022-11-11","2022-11-21","2022-11-15","2022-11-15"],"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":[["","65862058605","AMLOD\/BENAZP","CAP 10-20MG","30","Select","Select",""],["","50458057930","XARELTO","TAB 20MG","30","Select","Select",""],["","60505267108","ATORVASTATIN","TAB 80MG","30","Select","Select",""],["","16729018317","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","68001033508","LISINOPRIL","TAB 20MG","60","Select","Select",""],["","67877019905","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","57237001401","TAMSULOSIN","CAP 0.4MG","90","Select","Select",""],["","61442010210","DICLOFENAC","TAB 50MG DR","14","Select","Select",""],["","33342019307","AMLOD\/OLMESA","TAB 10-40MG","30","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","30","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","12","Select","Select",""],["","68462039610","OMEPRAZOLE","CAP 20MG","14","Select","Select",""],["","68001024617","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","68001015203","CARVEDILOL","TAB 25MG","60","Select","Select",""],["","67877049090","EZETIMIBE","TAB 10MG","30","Select","Select",""],["","64380073408","HYDRALAZINE","TAB 25MG","90","Select","Select",""],["","45802075830","PROMETHAZINE","SUP 12.5MG","20","Select","Select",""],["","65162059606","ASA\/DIPYRIDA","CAP 25-200MG","60","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","40","Select","Select",""],["","10572010101","PEG-3350","SOL ELECTROL","4,000.00","Select","Select",""],["","65862035705","CLOPIDOGREL","TAB 75MG","21","Select","Select",""],["","68382031910","TRAMADOL","TAB 50MG","24","Select","Select",""],["","62332000191","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","00074262528","MAVYRET","TAB 100-40MG","84","Select","Select",""],["","45963055550","GABAPENTIN","CAP 100MG","60","Select","Select",""],["","00023611501","ZENPEP","CAP 5000UNIT","120","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":""}]}]}