{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"IRDNAJELAOLERRU AN","gend":1,"add":" EVIRD   ESUOHBULC   T521                       WS","city":"LEESBURG                 ","state":"VA","zip":"20175-4222","dob":"1956-05-13","age":"","mstatus":"","insh":"10111082","cliId":"","pno":"0930763349","cno":"","email":"","ename":"","eno":"","pphy":"IMAM, SHAMIM A","ppno":7034710800,"pcpadd":"504 ELDEN STREET SUITE 3,","pcpcity":"HERNDON","pcpstate":"VA","pcpzip":201704741,"pcpcounty":"","pcpid":"","pcpname":"DULLES FAMILY MEDICINE PC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"UNIT 11                                           ","add3":"","madd1":"125T   CLUBHOUSE   DRIVE SW                       ","madd2":"UNIT 11                                           ","madd3":"","mcity":"LEESBURG                 ","mstate":"VA","mzip":"20175-4222","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.2","M54.16","M79.10","M79.7","J45.909","M81.0","K21.9","E11.9","E78.5","R07.9","I10","R94.31","F17.200","H26.492","H35.371","H01.003","H01.006","E11.65","Z79.84","Z68.35","I66.9","R12","M25.561","M17.0","E11.36","H43.392","Z11.52","Z20.822","R51.9","R05","Z12.11","E66.9","Z68.32","H10.45","H43.393","J45.21","R06.02","R06.2","G47.9","J44.9","E78.2","E66.3","F32.9","R31.9","Z13.820","K92.1","R10.13","Z59.8","R30.0","R10.30","M54.5","J45.40","H43.813","R91.8","Z72.0","Z87.891","Z23","Z12.39","J45.41","R07.89","R41.3","R10.12","R22.9","Z00.00","Z12.31","H04.123","Z96.1","R10.10","K59.00","Z86.19","R41.0","R91.1","F17.210","R10.33","K57.30","D12.2","D12.3","D12.4","D12.5","K62.1","Z79.899","Z79.82","G43.019","Z01.818"," ","J45.901","R06.09"],"date":["2022-10-19","2022-05-27","2022-05-27","2022-06-22","2022-11-02","2022-06-22","2022-08-29","2022-11-02","2022-08-29","2022-11-07","2022-10-17","2022-02-02","2022-02-02","2021-03-30","2021-03-23","2022-08-05","2022-08-05","2022-10-17","2022-10-25","2021-03-29","2021-03-29","2021-03-29","2021-03-29","2021-03-29","2021-04-05","2021-04-12","2021-04-26","2022-11-07","2021-04-26","2021-04-26","2022-10-25","2022-08-16","2022-08-16","2022-08-05","2021-05-03","2021-05-30","2022-03-02","2022-11-07","2021-05-30","2022-02-24","2021-05-30","2021-07-06","2021-08-23","2021-07-06","2021-12-30","2022-06-22","2021-07-15","2021-07-06","2020-07-10","2020-07-10","2020-07-10","2020-07-10","2021-07-21","2021-09-15","2021-09-15","2022-02-24","2022-11-02","2022-06-22","2022-02-24","2022-02-24","2022-06-22","2022-06-22","2022-11-02","2021-08-23","2022-10-12","2022-08-05","2022-08-05","2022-08-16","2022-08-16","2022-08-16","2022-10-24","2022-11-02","2022-11-02","2022-11-02","2022-10-25","2022-10-25","2022-10-25","2022-10-25","2022-10-25","2022-10-25","2022-10-25","2022-10-25","2022-10-19","2022-10-17","2022-11-07","2022-11-07","2022-11-07"],"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":[["","69097084507","CYCLOBENZAPR","TAB 5MG","12","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","51991074790","DULOXETINE","CAP 30MG","90","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","30","Select","Select",""],["","00173088210","BREO","INH 200-25","60","Select","Select",""],["","68180016006","AZITHROMYCIN","TAB 250MG","4","Select","Select",""],["","00378827052","ALBUTEROL","NEB 0.00083","75","Select","Select",""],["","70954006020","PREDNISONE","TAB 20MG","12","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0.30","Select","Select",""],["","69097015807","MELOXICAM","TAB 7.5MG","30","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","90","Select","Select",""],["","60758011905","PREDNISOLONE","SUS 1% OP","5","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","90","Select","Select",""],["","68382025016","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","48","Select","Select",""],["","68382076010","METFORMIN","TAB 1000MG","180","Select","Select",""],["","50458014030","INVOKANA","TAB 100MG","90","Select","Select",""],["","68180051201","LISINOPRIL","TAB 2.5MG","90","Select","Select",""],["","72205001390","PREGABALIN","CAP 75MG","89","Select","Select",""],["","00597016061","SPIRIVA","AER 1.25MCG","4","Select","Select",""],["","00006483703","PNEUMOVAX","INJ 25\/0.5","0.5","Select","Select",""],["","59310057922","PROAIR","AER ","8.5","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","64380076921","PEG-3350\/KCL","SOL \/SODIUM","4,000.00","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":["",""]}},{"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":""}]}]}