{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DAMMAHOMMEELAS ","gend":0,"add":"RAF 202NL LLER","city":"FREDERICKSBURG","state":"VA","zip":22401,"dob":"1957-08-14","age":"","mstatus":"","insh":"10115385","cliId":"","pno":"1704510130","cno":5407609153,"email":"","ename":"","eno":"","pphy":"ALEXANDER, DAWN","ppno":5407103101,"pcpadd":"10009 SOUTHPOINT PKWY ,STE 200","pcpcity":"FREDERICKSBURG","pcpstate":"VA","pcpzip":22407,"pcpcounty":"","pcpid":"","pcpname":"PRIMARY AND URGENT CARE LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"Central","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"202 FARRELL LN                                    ","madd2":"                                                  ","madd3":"","mcity":"FREDERICKSBURG           ","mstate":"VA","mzip":"22401-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I63.219","I25.10","Z95.1","J44.9","F17.210","E11.40","E78.5","I10","Z79.4","Z20.828","U07.1","K21.9","E11.43","R91.8","R53.83","R11.2","M54.5","I63.9","E11.9","W19.XXXA","I69.354","E66.9","I25.2","E11.65","M19.012","K31.84","Z23","M25.562","S42.035A","R07.9","W07.XXXA","S20.212A","R03.0","Z86.16","Z87.01","Z96.1","R29.6","M53.3","R53.1","E11.42","I70.292","M79.672","M79.671","B35.1","L60.2","L60.0","I89.0","G89.29","R07.89","R06.02","S50.312A","M54.6","Z20.822","W10.9XXA","Y92.009","E23.2","Z72.0","M25.512","G47.00","R40.0","R00.1","M79.675","T14.90XA","M79.89","R05","R50.9","J12.89","J44.0","R91.1","R59.0","R09.02","Z03.818","I63.89","N40.0","Y92.89","Y93.89","Y92.018","I66.01","M51.36","M47.816","I65.23","N39.45","E11.8","E78.00","S91.202A","W23.1XXA","S91.209A","R20.0","W18.09XA","Z86.73","Z83.3","Z82.49","S29.9XXA","R47.81","I69.854","N32.81","E13.610","J18.9","Z22.7","S39.93XA","S19.9XXA","S09.90XA","M54.2","G45.9","S42.032A","I70.212","R29.810","R39.15","Z87.09","Z87.891","W01.0XXA","R69","Z79.899","S36.209A","M79.622","M25.522","M25.559","S42.035D","R46.0","J10.1","R79.0","E87.1","R05.9","E83.42","Z79.84","Z90.49","S91.219A","L60.8","M62.830","K21.00"," "],"date":["2020-09-23","2022-10-24","2022-10-24","2020-10-26","2022-10-24","2020-09-23","2022-02-23","2022-10-24","2022-10-26","2021-02-20","2020-10-26","2022-02-23","2022-10-24","2020-09-30","2022-02-23","2022-10-24","2021-05-08","2022-05-27","2022-02-23","2021-05-08","2021-08-19","2020-10-26","2022-10-24","2022-10-26","2020-09-01","2022-10-24","2022-10-24","2020-09-01","2021-08-30","2022-10-25","2021-08-30","2021-08-19","2021-08-19","2022-10-24","2021-08-19","2021-08-19","2020-09-23","2020-09-01","2020-09-05","2022-10-26","2022-10-26","2021-08-10","2021-08-10","2022-10-26","2022-10-26","2021-08-10","2022-10-26","2021-08-10","2021-05-08","2021-05-08","2021-05-08","2021-05-08","2022-10-24","2021-05-08","2021-05-08","2022-08-05","2020-09-08","2022-02-23","2020-09-08","2020-09-08","2020-09-08","2022-05-21","2022-05-21","2022-05-21","2020-09-27","2020-09-27","2020-10-03","2020-10-03","2020-09-30","2020-09-30","2020-09-30","2021-02-20","2022-02-23","2022-02-23","2022-05-21","2022-05-21","2021-08-30","2020-10-26","2020-09-02","2020-09-02","2020-09-05","2020-12-15","2020-12-15","2020-12-15","2022-05-21","2022-05-21","2022-05-21","2022-05-21","2022-05-21","2022-10-24","2022-05-21","2022-05-21","2021-05-08","2020-09-05","2022-02-23","2022-05-27","2021-09-11","2020-10-02","2020-10-02","2021-05-08","2021-05-08","2021-05-08","2021-05-08","2020-09-02","2021-08-19","2021-05-18","2020-09-01","2020-10-26","2020-09-26","2021-08-19","2021-08-19","2020-09-08","2021-09-15","2021-09-15","2021-05-08","2021-05-08","2020-09-02","2021-10-19","2022-10-26","2022-10-25","2022-10-25","2022-10-25","2022-10-24","2022-10-24","2022-10-24","2022-10-24","2022-05-27","2022-05-27","2022-05-27","2022-05-27","2022-10-26"],"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":[["","68180012202","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","70377002911","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","50742061510","METOPROL","TAB 25MG ER","90","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","180","Select","Select",""],["","00002773701","INSULIN","INJ 100\/ML","10","Select","Select",""],["","60505014201","GLIPIZIDE","TAB 10MG","180","Select","Select",""],["","51224010750","METFORMIN","TAB 750MG ER","90","Select","Select",""],["","65862086001","FAMOTIDINE","TAB 40MG","90","Select","Select",""],["","65862035790","CLOPIDOGREL","TAB 75MG","90","Select","Select",""],["","33342002208","LEVOFLOXACIN","TAB 500MG","10","Select","Select",""],["","00088222033","LANTUS","INJ 100\/ML","20","Select","Select",""],["","68180023209","FENOFIBRATE","TAB 160MG","90","Select","Select",""],["","60505025103","TIZANIDINE","TAB 2MG","30","Select","Select",""],["","68180098103","LISINOPRIL","TAB 20MG","180","Select","Select",""],["","67877012420","SILVER","CRE 0.01","20","Select","Select",""],["","68382025601","OXYBUTYNIN","TAB 10MG ER","90","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","00169266015","TRESIBA","INJ 100UNIT","15","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","1","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","08290320119","BD  PEN NEEDL","MIS 31GX5MM","300","Select","Select",""],["","68180016111","AZITHROMYCIN","TAB 500MG","2","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","68180067711","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","00093005805","TRAMADOL","TAB 50MG","40","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","100","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}