{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RUHTRACAMRJ RESIK ","gend":0,"add":"xoB OP4631 ","city":"Saint Paul","state":"VA","zip":"24283-1364","dob":"1970-10-04","age":"","mstatus":"","insh":"0157556","cliId":"","pno":"1267292740","cno":2762104729,"email":"","ename":"","eno":"","pphy":"YOUSUF, SAMINA","ppno":2768890433,"pcpadd":"142 Highland Dr, ","pcpcity":"Lebanon","pcpstate":"VA","pcpzip":242664636,"pcpcounty":"","pcpid":"","pcpname":"COMMUNITY MEDICAL CARE","ano":"","add2":"                                                            ","add3":"","madd1":"15 Clay St","madd2":"                                                            ","madd3":"","mcity":"Castlewood","mstate":"VA","mzip":"24224-5416","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","H52.223","H52.4","S83.241D","S83.281A","M23.91","I10","K76.0","K74.60","M17.11","S83.200D","E78.5","E11.40","B18.1","I85.00","E78.2","E11.49","M46.07","F17.210","E11.65","J20.9","S83.241A","M54.5","E66.09","Z68.33","M25.562","M25.561","Z68.32","B18.2","M51.36","E66.9","Z68.31","R53.83","Z79.891","K21.9","J30.1","F51.01","M47.816","M54.9","Z01.810","M17.0","M67.51","F17.200","J44.9","B19.10","Z79.84","M25.572","Z12.5","M23.92","S83.242D","F33.0","I85.10","Z79.899","M25.78","Z13.83"],"date":["2019-07-15","2019-03-13","2019-03-13","2019-07-15","2019-07-15","2019-07-15","2021-03-24","2019-12-23","2020-06-25","2020-03-17","2019-07-17","2020-07-01","2021-03-24","2020-06-04","2019-11-25","2021-03-24","2021-03-24","2020-08-26","2021-03-24","2019-03-27","2019-03-27","2019-07-15","2020-06-25","2020-01-23","2019-11-07","2019-09-12","2020-03-19","2020-01-23","2020-06-25","2021-03-24","2020-02-20","2020-02-20","2020-06-05","2020-07-29","2019-07-15","2019-05-23","2019-05-23","2020-06-25","2020-06-25","2019-07-09","2019-01-31","2019-07-15","2019-07-15","2019-07-15","2019-07-15","2019-07-15","2019-11-07","2021-03-24","2019-05-23","2019-06-25","2021-03-24","2020-06-04","2020-07-29","2020-06-25","2021-03-24"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","43386043001","OXYCODONE ","TAB 15MG","75","Select","Select",""],["","00781223401","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","00904671772","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","00093720110","PRAVASTATIN ","TAB 20MG","30","Select","Select",""],["","23155010305","METFORMIN ","TAB 850MG","90","Select","Select",""],["","00002143380","TRULICITY ","INJ 0.75\/0.5","2","Select","Select",""],["","65862052401","GABAPENTIN ","TAB 800MG","90","Select","Select",""],["","56151014701","TRUPLUS ","MIS 33G","100","Select","Select",""],["","60505014200","GLIPIZIDE ","TAB 10MG","120","Select","Select",""],["","64380073706","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","13107000334","MIRTAZAPINE ","TAB 30MG","30","Select","Select",""],["","00006027731","JANUVIA ","TAB 100MG","30","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","68180098003","LISINOPRIL ","TAB 10MG","30","Select","Select",""],["","00310621030","FARXIGA ","TAB 10MG","30","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","TES LITE","50","Select","Select",""],["","16714082001","TENOFOVIR ","TAB 300MG","90","Select","Select",""],["","00169369619","NOVOLOG ","INJ FLEXPEN","3","Select","Select",""],["","00172392660","DIAZEPAM ","TAB 5MG","2","Select","Select",""],["","08222710031","PEN  NEEDLES  ","MIS 32GX4MM","30","Select","Select",""],["","67877019805","AMLODIPINE ","TAB 5MG","60","Select","Select",""],["","08290320122","BD  PEN NEEDL","MIS 32GX4MM","30","Select","Select",""],["","55566410001","EUFLEXXA ","INJ 10MG\/ML","6","Select","Select",""],["","00536110301","ALCOHOL ","PAD 0.7","100","Select","Select",""],["","67405060301","FLUCONAZOLE ","TAB 150MG","3","Select","Select",""],["","56151014201","TRUEDRAW ","MIS LANC DEV","1","Select","Select",""],["","45802005911","NYSTATIN ","CRE 100000","30","Select","Select",""],["","45802011222","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","00781577626","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","00603158658","PROMETHAZINE ","SYP DM","118","Select","Select",""],["","99073070805","FREESTYLE    MIS LITE","MIS LITE","1","Select","Select",""],["","00781261305","AMOXICILLIN ","500MG","21","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}