{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TENAJESOR ","gend":1,"add":"UBNAB 402EUNEVA YR","city":"PETERSBURG","state":"VA","zip":"23805-8753","dob":"1967-02-18","age":"","mstatus":"","insh":"50013530","cliId":"","pno":"3540890416","cno":"","email":"","ename":"","eno":"","pphy":"FAROOQ, MOHAMMAD","ppno":8045411445,"pcpadd":"12712 Bay Hill Drive, ","pcpcity":"CHESTER","pcpstate":"VA","pcpzip":238362680,"pcpcounty":"","pcpid":"","pcpname":"PULMONARY AND CRITICAL CARE ASSOCIATES","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"204 BANBURY AVENUE","madd2":"","madd3":"","mcity":"PETERSBURG","mstate":"VA","mzip":"23805-8753","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","E78.00","L03.116","M19.90","K21.9","E66.09","Z68.38","R31.29","N28.1","R31.9","M79.672","R10.9","R30.0","K59.00","F32.9","G47.00","E11.9","R60.0","M25.50","Z68.37","Z23","R05","J96.01","U07.1","J12.89","R06.02","J96.00","I51.7","N17.9","Y92.239","Y84.6","I26.99","N17.0","R57.1","J44.0","G72.81","K65.1","E43","J12.82","A41.9","I13.2","K56.600","R91.8","J98.4","Z99.11","K66.1","J98.11","J96.90","Z45.2","R18.8","N13.30","N13.4","I82.409","J90","Z68.33","I36.1","E87.0","R60.9","E87.70","J81.0","J96.10","R41.82","J81.1","M79.81","I12.9","N18.30","E86.1","R14.0","D72.829","K92.2","R65.20","D50.0","D64.9","E87.2","R65.21","I95.9","I82.401","R58","I82.4Y2","M79.606","J98.19","I82.402","D69.6","R65.10","D62","Z86.19","I82.412","I82.432","I82.812","K56.699","N32.89","N32.9","N20.0","K80.20","I47.1","R22.42","R50.9","Z86.16","J18.9","N39.0","K56.609","S36.892A","K92.0","D50.9","R31.0","B96.20","R78.81","B96.29","R39.0","J12.81","B37.49","N35.92","E66.01","Z68.41","R39.14","D49.4","R33.8","N30.00","S37.20XA","N30.01","B49","Z68.31","Z68.34","Z68.42","J91.8","K62.5","I82.499","S36.892D","B96.1","A41.89","N94.89","N73.9","Z68.35","B95.2","N31.0","Z16.21","S37.29XS","S37.22XS","N73.8","S37.29XA","N30.21","I26.09","I27.0","L08.9","B96.5","M10.9","Z48.816","Z46.6","Z68.27","R00.0","M10.00","M17.12","M25.562","M62.81","R52","I27.82","N99.72","Z79.82","Z95.828","Z00.00","I89.0","Z01.812","Z20.822","B97.29","Z87.442","Z68.36","M25.561","J01.90","M25.462","M79.89","R68.84","Z12.31"],"date":["2021-10-26","2020-09-22","2020-02-10","2021-05-11","2021-11-15","2020-08-25","2020-02-10","2020-02-26","2021-02-12","2021-04-01","2020-04-30","2021-01-06","2020-12-10","2020-05-18","2021-11-15","2020-08-25","2020-11-21","2020-11-21","2020-11-21","2020-11-21","2021-10-26","2020-12-10","2021-04-07","2021-04-07","2021-05-03","2020-12-12","2021-03-17","2021-03-29","2021-04-07","2020-12-12","2020-12-12","2021-04-21","2020-12-12","2020-12-23","2020-12-12","2021-04-21","2021-04-01","2021-04-21","2021-03-17","2021-02-04","2020-12-12","2020-12-12","2020-12-21","2021-01-06","2020-12-14","2021-03-01","2021-02-12","2021-02-27","2021-02-02","2021-02-12","2020-12-14","2020-12-14","2021-04-01","2021-02-12","2021-03-08","2020-12-16","2021-01-19","2021-03-18","2021-01-14","2021-02-12","2020-12-20","2021-02-04","2020-12-20","2021-03-02","2021-11-15","2020-12-20","2020-12-21","2021-01-10","2020-12-29","2021-04-07","2020-12-23","2020-12-29","2021-03-08","2021-02-08","2020-12-29","2020-12-21","2020-12-21","2021-04-01","2021-02-25","2020-12-23","2020-12-25","2021-04-21","2021-03-17","2021-01-10","2021-04-01","2021-01-06","2021-01-05","2021-01-05","2021-01-05","2021-01-19","2021-05-03","2021-01-06","2021-02-27","2021-01-06","2021-01-24","2021-01-09","2021-01-09","2021-05-03","2021-01-10","2021-04-21","2021-03-02","2021-02-01","2021-01-12","2021-01-12","2021-03-08","2021-01-14","2021-02-19","2021-02-24","2021-01-12","2021-03-17","2021-01-17","2021-01-15","2021-04-21","2021-01-22","2021-01-15","2021-02-11","2021-01-18","2021-01-21","2021-01-21","2021-03-15","2021-02-03","2021-01-22","2021-09-15","2021-01-25","2021-04-07","2021-04-07","2021-04-07","2021-02-01","2021-02-15","2021-02-01","2021-02-03","2021-03-15","2021-03-08","2021-03-07","2021-02-07","2021-03-07","2021-02-11","2021-02-11","2021-02-11","2021-02-11","2021-02-18","2021-02-24","2021-11-15","2021-02-24","2021-02-24","2021-10-26","2021-03-17","2021-04-21","2021-03-17","2021-03-17","2021-03-17","2021-03-18","2021-03-18","2021-03-18","2021-03-18","2021-11-15","2021-04-21","2021-04-21","2021-04-21","2021-04-15","2021-10-26","2021-04-29","2021-04-29","2021-05-03","2021-05-03","2021-05-03","2021-05-11","2021-06-21","2021-07-15","2021-07-15","2019-04-29","2019-05-17"],"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":{"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":[["","49483060450","IBUPROFEN","TAB 800MG","90","Select","Select",""],["","50742061710","METOPROL","TAB 100MG ER","180","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","50111056101","TRAZODONE","TAB 100MG","30","Select","Select",""],["","13668001005","CITALOPRAM","TAB 20MG","30","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","00378021610","FUROSEMIDE","TAB 40MG","30","Select","Select",""],["","68180051703","LISINOPRIL","TAB 40MG","30","Select","Select",""],["","68382002310","ATENOLOL","TAB 50MG","30","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","00591565810","CYCLOBENZAPR","TAB 10MG","60","Select","Select",""],["","50428053491","CVS","TAB 81MG EC","30","Select","Select",""],["","00536114941","ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","31722070290","LOSARTAN","TAB 100MG","90","Select","Select",""],["","00245531911","KLOR-CON","TAB 20MEQ ER","30","Select","Select",""],["","55111072901","ALLOPURINOL","TAB 100MG","30","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","180","Select","Select",""],["","13668013701","ESCITALOPRAM","TAB 20MG","30","Select","Select",""],["","00603188016","LIDOCAINE","PAD 0.05","14","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","16","Select","Select",""],["","00093083205","CLONAZEPAM","TAB 0.5MG","30","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","27","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0.5","Select","Select",""],["","23155000301","HYDRALAZINE","TAB 50MG","90","Select","Select",""],["","00228202950","ALPRAZOLAM","TAB 0.5MG","60","Select","Select",""],["","67877057505","BENZONATATE","CAP 200MG","30","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","00093226301","AMOXICILLIN","TAB 500MG","30","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}