{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" C ARASREPRAH","gend":1,"add":"      RD EERT YRREHC 6108                         ","city":"FREDERICKSBURG           ","state":"VA","zip":"22407-9998","dob":"1964-05-21","age":"","mstatus":"","insh":"10112475","cliId":"","pno":"9804595361","cno":"","email":"","ename":"","eno":"","pphy":"ANSARI, NATHER B","ppno":5407859900,"pcpadd":"2306 PLANK RD STE 100,","pcpcity":"Fredericksburg","pcpstate":"VA","pcpzip":224014902,"pcpcounty":"","pcpid":"","pcpname":"PRIMARY AND URGENT CARE LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"8016 CHERRY TREE DR                               ","madd2":"                                                  ","madd3":"","mcity":"FREDERICKSBURG           ","mstate":"VA","mzip":"22407-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G80.9","I10","G89.29","Z79.891","Z51.81","M79.2","M79.7","G89.4","F33.0","J45.909","N20.0","E66.01","Z99.81","M17.0","Z99.3","R26.0","Z68.42","M54.50","R09.02","A41.9","Z53.09","Z87.440","E66.9","R39.81","K56.41","L22","G82.20","G47.30","Z87.442","Z91.041","Z79.51","Z79.82","Z79.899","R69","Z01.818","N13.2","R30.0","E11.42","Z68.43","K76.0","G47.33","F41.9","K59.03","T40.2X5A","N30.00","R10.31","R10.32","N20.2","N32.89","E11.9","F41.8","Z46.6","A00.0","M54.5","S92.811S","R52","J96.21","I21.4","J18.9","E66.2","N39.0","J98.11","M54.9","R05","Z20.822","R10.9","Z82.49","R10.84","R11.2","J18.1","R51.9","R42","R11.0","R11.10","R50.9","J96.01","I16.0","J16.8","R77.8","N20.1","D72.829","J44.0","E78.5","F44.4","F79","G43.909","R06.02","I11.9","R00.0","I51.7","I34.0","R79.89","R07.9","R23.2","E11.65","Z74.01","M79.18","G80.1","K12.1","Z87.09","R35.0","Z80.42","R53.81","R53.1","B96.20","F32.9","Z11.59","R06.9","R79.9","R78.81","Z20.828","G56.03","R60.9","R53.83","G62.9","R25.2","R29.898","R26.89","R26.2","Z91.81","M62.81","K52.9","N30.01","A09","J45.901","B95.2","Z23","K59.00","Z88.5","Z20.9","I25.2","J44.9","N30.90","J96.02","Z46.82","N13.6","Z43.6","Z48.816","F32.A","Z68.41","E87.2","F33.42","I27.20","E11.40","G89.18","Z98.890","J96.11","M54.51","M25.511","G80.0"," "],"date":["2022-11-30","2022-03-23","2022-09-15","2022-09-15","2022-09-15","2022-06-30","2022-04-28","2022-03-23","2021-11-18","2022-11-01","2022-11-09","2022-03-27","2022-11-01","2022-02-13","2022-02-16","2020-12-26","2022-02-16","2022-11-28","2022-03-23","2022-11-01","2021-01-04","2021-01-04","2022-02-16","2022-11-25","2022-11-25","2022-11-25","2022-11-25","2022-03-22","2022-02-16","2021-02-01","2021-02-01","2021-02-01","2021-02-01","2021-02-01","2021-02-01","2022-03-27","2022-02-05","2022-03-27","2022-02-08","2022-02-05","2022-04-29","2022-04-28","2022-02-05","2022-02-05","2022-02-08","2022-02-05","2022-02-05","2022-02-10","2022-02-10","2022-04-29","2022-03-22","2022-04-28","2022-03-29","2021-09-23","2021-03-15","2021-03-17","2021-11-18","2021-04-16","2021-04-13","2022-03-23","2022-04-29","2022-03-23","2021-04-16","2021-03-17","2021-04-13","2022-02-16","2022-02-16","2021-03-17","2021-03-17","2021-04-13","2021-04-16","2021-04-16","2021-10-25","2021-04-13","2021-04-13","2022-03-29","2021-04-13","2021-04-13","2021-04-13","2022-03-25","2021-04-13","2021-04-13","2021-04-13","2021-04-13","2021-04-13","2022-03-22","2022-03-23","2022-04-28","2021-04-13","2021-04-16","2021-04-16","2021-04-16","2022-03-23","2021-04-16","2021-10-14","2022-02-16","2021-06-25","2021-11-18","2020-11-21","2020-11-21","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-09-09","2020-09-09","2020-09-09","2020-09-09","2020-09-10","2020-09-11","2020-09-09","2020-09-20","2020-09-20","2020-09-20","2020-09-20","2020-09-20","2020-09-20","2020-09-20","2020-09-20","2020-09-20","2020-10-06","2022-02-13","2020-11-21","2020-11-21","2020-11-21","2020-11-17","2020-11-17","2020-11-17","2020-11-17","2020-11-16","2021-11-18","2021-11-18","2020-11-21","2022-03-29","2022-03-29","2022-02-13","2022-02-13","2022-04-28","2022-04-28","2022-03-27","2022-03-23","2022-03-23","2022-03-23","2022-03-23","2022-02-16","2022-03-23","2022-04-29","2022-06-30","2022-09-15","2022-04-26","2022-11-30"],"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":[["","50228035490","PREGABALIN","CAP 150MG","60","Select","Select",""],["","57237001930","DULOXETINE","CAP 60MG","60","Select","Select",""],["","64764024060","AMITIZA","CAP 24MCG","60","Select","Select",""],["","24979003801","METOPROL","TAB 50MG ER","30","Select","Select",""],["","47781022901","OXYCOD\/APAP","TAB 7.5-325","60","Select","Select",""],["","67877019805","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","65162074510","PROMETHAZINE","TAB 12.5MG","90","Select","Select",""],["","65862016801","ATENOLOL","TAB 25MG","90","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","28","Select","Select",""],["","47781030701","NITROFUR","CAP 50MG","60","Select","Select",""],["","62756014202","METFORMIN","TAB 500MG ER","360","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","TES LITE","100","Select","Select",""],["","57664050389","TIZANIDINE","TAB 4MG","120","Select","Select",""],["","59762444002","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","20","Select","Select",""],["","68180030320","CEFUROXIME","TAB 500MG","16","Select","Select",""],["","66689000816","NYSTATIN","SUS 100000","200","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","15","Select","Select",""],["","68180098103","LISINOPRIL","TAB 20MG","30","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","15","Select","Select",""],["","65162027250","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","99073070805","FREESTYLE    MIS LITE","MIS LITE","1","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100","Select","Select",""],["","67877047380","LIDOCAINE","OIN 0.05","250","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","42","Select","Select",""],["","00143314250","DOXYCYCL","CAP 100MG","14","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","24","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}