{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"J SITELCWOLKCIN ","gend":0,"add":"RAS 13553TS ATOSA","city":"Round Hill","state":"VA","zip":"20141-9998","dob":"1957-12-29","age":"","mstatus":"","insh":"10115296","cliId":"","pno":"7240363556","cno":"","email":"","ename":"","eno":"","pphy":"SIDDOQI, MUHAMMAD M","ppno":7038510315,"pcpadd":"3180 FAIRVIEW PARK DR STE 500,STE 500","pcpcity":"Falls Church","pcpstate":"VA","pcpzip":"22042-4583","pcpcounty":"","pcpid":"","pcpname":"CAPITAL PALLIATIVE CARE CONSULTANTS LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"N","ano":"","add2":"","add3":"","madd1":"35531 SARASOTA ST","madd2":"","madd3":"","mcity":"Round Hill","mstate":"VA","mzip":"20141-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N18.6","N25.81","D50.9","Z23","Z99.2","Z93.3","Z93.2","Z93.6","C67.9","C61","C18.9","N13.30","Z85.51","Z85.038","Z51.5","G89.3","K59.00","M79.2","N13.5","Z43.6","J44.9","Z89.512","F41.1","F32.5","Z68.32","E78.2","F17.210","G47.33","K21.9","N28.9","F17.200","Z79.51","Z79.899","Z92.3","Z22.322","Z90.6","Z90.79","T83.092A","I10","J18.1","Z01.818","Z20.822","R11.0","R10.30","N99.520","Z85.46","Z12.2","K43.5","R91.8","I25.10"],"date":["2023-07-03","2022-12-02","2023-07-03","2022-10-03","2023-07-03","2023-08-01","2023-08-01","2023-08-01","2023-08-01","2023-08-01","2023-08-01","2023-08-01","2023-08-01","2023-08-01","2023-07-21","2023-07-21","2023-07-21","2023-07-21","2022-06-20","2023-04-21","2023-01-18","2022-03-01","2022-03-01","2022-03-01","2022-03-01","2022-09-23","2023-01-18","2023-01-18","2022-09-23","2021-09-24","2021-09-24","2021-09-24","2021-09-24","2023-01-27","2021-09-24","2021-06-18","2021-03-12","2022-10-17","2022-10-17","2022-10-17","2021-03-09","2021-03-09","2022-10-17","2022-10-17","2022-10-17","2023-01-27","2023-01-18","2023-01-26","2023-01-26","2023-01-26"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"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":[["","00597002402","COMBIVENT","AER 20-100","4","Select","Select",""],["","64980041310","PREGABALIN","CAP 100MG","60","Select","Select",""],["","10702005650","OXYCODONE","TAB 10MG","120","Select","Select",""],["","59011044010","OXYCONTIN","TAB 40MG ER","60","Select","Select",""],["","00054032756","FLUTIC\/SALME","AER 250\/50","60","Select","Select",""],["","68462039610","OMEPRAZOLE","CAP 20MG","60","Select","Select",""],["","68001024617","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","50111078751","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00781261301","AMOXICILLIN","CAP 500MG","20","Select","Select",""],["","00597002402","COMBIVENT AER","20-100","4","Select","Select",""],["","64980041310","PREGABALIN CAP","100MG","60","Select","Select",""],["","10702005650","OXYCODONE TAB","10MG","120","Select","Select",""],["","59011044010","OXYCONTIN TAB","40MG ER","60","Select","Select",""],["","00054032756","FLUTIC\/SALME AER","250\/50","60","Select","Select",""],["","68462039610","OMEPRAZOLE CAP","20MG","60","Select","Select",""],["","68001024617","ONDANSETRON TAB","4MG ODT","20","Select","Select",""],["","50111078751","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","00781261301","AMOXICILLIN CAP","500MG","20","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":""}]}]}