{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" M YMAENYAL","gend":1,"add":"  ECALP ELLEBIRAM   29251                         ","city":"WOODBRIDGE               ","state":"VA","zip":"22193-9998","dob":"1975-10-28","age":"","mstatus":"","insh":"10115893","cliId":"","pno":"7240888411","cno":"","email":"","ename":"","eno":"","pphy":"ABBASI, GOHAR MAQSOOD","ppno":8045305293,"pcpadd":"1714 E HUNDRED RD STE 101,","pcpcity":"Chester","pcpstate":"VA","pcpzip":238363310,"pcpcounty":"","pcpid":"","pcpname":"PRIME CARE HEALTH SERVICES PC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"N","ano":"","add2":"                                                  ","add3":"","madd1":"15292   MARIBELLE PLACE                           ","madd2":"                                                  ","madd3":"","mcity":"WOODBRIDGE               ","mstate":"VA","mzip":"22193-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.9","F39","R45.4","F33.9","E78.5","E03.9","E78.00","M54.5","Z13.89","F70","Z01.419","Z11.51","E66.01","E66.8","Z12.31","Z30.09","R30.0","E55.9","R56.9","Z76.89","F32.89","F60.9","Z68.41","J30.9","F41.3","F32.0","G43.009","R07.81","N64.89","G64","G89.29","R32","E78.49","N90.89","Z79.899","M70.61"," ","Z20.822","J00"],"date":["2021-01-07","2021-01-07","2021-01-07","2020-06-30","2020-09-29","2020-09-29","2020-06-30","2021-02-17","2020-06-02","2022-07-01","2021-08-23","2021-08-23","2022-07-25","2021-03-04","2021-08-24","2020-07-31","2020-07-31","2021-11-16","2022-07-25","2020-06-25","2020-06-25","2020-06-25","2020-07-21","2022-03-28","2021-11-16","2021-03-04","2022-07-25","2020-06-02","2021-09-22","2021-03-04","2020-07-21","2022-03-28","2022-07-25","2022-04-05","2022-07-05","2022-08-29","2022-10-23","2022-10-23","2022-10-23"],"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":[["","65162083366","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","00115165903","PROPRANOLOL","TAB 10MG","270","Select","Select",""],["","68462030929","NORGEST\/ETHI","TAB 0.25\/35","28","Select","Select",""],["","27241005508","ARIPIPRAZOLE","TAB 20MG","30","Select","Select",""],["","00093506110","HYDROXYZ","TAB 25MG","30","Select","Select",""],["","65862077685","MILI","TAB 0.25\/35","28","Select","Select",""],["","50474057066","BRIVIACT","TAB 50MG","60","Select","Select",""],["","00378025701","HALOPERIDOL","TAB 1MG","30","Select","Select",""],["","60505367503","PAROXETIN","TAB 37.5MG","58","Select","Select",""],["","49884005501","IMIPRAM","TAB 25MG","30","Select","Select",""],["","68382013905","TOPIRAMATE","TAB 50MG","31","Select","Select",""],["","00555901658","SPRINTEC","TAB 28 DAY","84","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","60","Select","Select",""],["","70700011985","ESTARYLLA","TAB 0.25-35","28","Select","Select",""],["","13668000805","ZOLPIDEM","TAB 10MG","30","Select","Select",""],["","00093083205","CLONAZEPAM","TAB 0.5MG","30","Select","Select",""],["","31722054301","INDOMETHACIN","CAP 50MG","20","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","68180016011","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","43547040550","METHOCARBAM","TAB 500MG","40","Select","Select",""],["","60432026415","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","21","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":""}]}]}