{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"C TERAGRAMZENITRAM ","gend":1,"add":"ALLAG 56401YAW XOF TN","city":"Ruther Glen","state":"VA","zip":"22546-9998","dob":"1964-07-22","age":"","mstatus":"","insh":"10112167","cliId":"","pno":"8540884929","cno":8049947695,"email":"","ename":"","eno":"","pphy":"SOHAIL, IRUM","ppno":8044480198,"pcpadd":"8051 PROSPERITY WAY STE 100,","pcpcity":"Ruther Glen","pcpstate":"VA","pcpzip":"22546-5812","pcpcounty":"","pcpid":"","pcpname":"MARY WASHINGTON FAMILY MEDICINE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"10465 GALLANT FOX WAY","madd2":"","madd3":"","mcity":"Ruther Glen","mstate":"VA","mzip":"22546-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E13.9","C95.11","G47.33","G62.9","E04.1","E11.8","Z94.81","E55.9","E78.49","E11.65","E11.40","E78.5","M81.0","E66.9","I10","Z86.39","Z79.899","Z79.4","Z79.52","D89.811","R06.83","C92.10","Z71.9","E04.2"],"date":["2023-05-31","2023-05-31","2021-11-16","2022-06-21","2022-06-21","2022-06-21","2022-09-20","2022-09-20","2022-06-21","2022-09-20","2022-09-20","2022-09-20","2022-09-20","2022-09-20","2022-09-20","2022-09-20","2022-09-20","2022-09-20","2022-09-20","2022-07-28","2021-05-11","2021-05-11","2021-11-16","2023-06-20"],"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":[["","51672125801","CLOBETASOL","CRE 0.0005","45","Select","Select",""],["","08290320550","BD PEN NEEDL","MIS 32GX5\/32","100","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","3","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","15","Select","Select",""],["","68462026290","ROSUVASTATIN","TAB 10MG","90","Select","Select",""],["","43598043601","NITROGLYCERN","SUB 0.4MG","100","Select","Select",""],["","33342004810","IRBESARTAN","TAB 150MG","30","Select","Select",""],["","29300039810","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","70954005820","PREDNISONE","TAB 5MG","45","Select","Select",""],["","00169413212","OZEMPIC","INJ 2\/1.5ML","1.5","Select","Select",""],["","53885092701","ONETOUCH","KIT VERIO RE","1","Select","Select",""],["","73070010315","INSULIN ASPA","INJ FLEXPEN","15","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","100","Select","Select",""],["","63304073430","ESOMEPRA MAG","CAP 20MG DR","90","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","55111046601","METOPROL SUC","TAB 25MG ER","90","Select","Select",""],["","00054032756","FLUTIC\/SALME","AER 250\/50","60","Select","Select",""],["","00023916360","RESTASIS","EMU 0.05% OP","60","Select","Select",""],["","08290320550","BD  PEN NEEDL","MIS 32GX5\/32","100","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","3","Select","Select",""],["","73070010315","INSULIN","INJ FLEXPEN","15","Select","Select",""],["","63304073430","ESOMEPRA","CAP 20MG DR","90","Select","Select",""],["","55111046601","METOPROL","TAB 25MG ER","90","Select","Select",""],["","51672125801","CLOBETASOL CRE","0.05%","45","Select","Select",""],["","08290320550","BD PEN NEEDL MIS","32GX5\/32","100","Select","Select",""],["","00088221905","LANTUS SOLOS INJ","100\/ML","3","Select","Select",""],["","00169633910","NOVOLOG INJ FLEXPEN","","15","Select","Select",""],["","68462026290","ROSUVASTATIN TAB","10MG","90","Select","Select",""],["","43598043601","NITROGLYCERN SUB","0.4MG","100","Select","Select",""],["","33342004810","IRBESARTAN TAB","150MG","30","Select","Select",""],["","29300039810","AMLODIPINE TAB","10MG","30","Select","Select",""],["","70954005820","PREDNISONE TAB","5MG","45","Select","Select",""],["","00169413212","OZEMPIC INJ","2\/1.5ML","1.5","Select","Select",""],["","53885027210","ONETOUCH TES VERIO","","100","Select","Select",""],["","73070010315","INSULIN ASPA INJ FLEXPEN","","15","Select","Select",""],["","53885000810","ONETOUCH DEL MIS PLUS","33G","100","Select","Select",""],["","63304073430","ESOMEPRA MAG CAP","20MG DR","90","Select","Select",""],["","53885092701","ONETOUCH KIT VERIO RE","","1","Select","Select",""],["","69097094312","GABAPENTIN CAP","300MG","90","Select","Select",""],["","55111046601","METOPROL SUC TAB","25MG ER","90","Select","Select",""],["","00054032756","FLUTIC\/SALME AER","250\/50","60","Select","Select",""],["","00023916360","RESTASIS EMU","0.05% OP","60","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":""}]}]}