{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" J   AMLAYTREHGUAD","gend":1,"add":"ENWAHS 02031 TPA RD E","city":"WINCHESTER","state":"VA","zip":"22601-9998","dob":"1960-02-10","age":"","mstatus":"","insh":"15000910*081","cliId":"","pno":"77\/0453853-3","cno":" ","email":"","ename":"","eno":"","pphy":"ALBEDRANI, KHALID MD","ppno":"540\/722-2369","pcpadd":"1330 AMHERST STREET, SUITE C","pcpcity":"WINCHESTER","pcpstate":"VA","pcpzip":22601,"pcpcounty":"","pcpid":"","pcpname":"SHENANDOAH VALLEY MEDICAL SYSTEM INC","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":" ","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","R73.03","J98.01","E11.9","R06.02","Z20.822","R07.9","R60.0","J44.9","J30.2","Z74.09","Z78.9","Z99.89","Z23.","D50.9","E11.65","E55.9","E78.2","Z11.4","Z12.11","Z00.00","Z12.39","Z91.81","E11.42","M87.052","R79.89","G89.29","M19.90","I50.30","R73.09","R00.2","H66.90","F32.A"],"date":["2022-07-14","2022-07-14","2022-07-06","2022-07-06","2022-07-06","2022-07-06","2022-07-06","2022-03-10","2022-11-10","2022-07-14","2022-07-14","2022-07-14","2022-07-14","2022-07-14","2022-07-28","2022-07-28","2022-07-28","2022-07-28","2022-07-28","2022-07-28","2022-07-28","2022-07-28","2022-07-28","2022-10-03","2022-10-03","2022-10-03","2022-10-03","2022-10-03","2022-10-13","2022-10-03","2022-10-03","2022-10-03","2022-10-03"],"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":[["","76204020025","ALBUTEROL SULFATE","NEB 0.00083","150","Select","Select",""],["","59762371903","ALPRAZOLAM","TAB 0.25MG","7","Select","Select",""],["","00173087310","INCRUSE ELLIPTA","INH 62.5MCG","90","Select","Select",""],["","69097084615","CYCLOBENZAPRINE HYDROCHLORIDE","TAB 10MG","20","Select","Select",""],["","65862020199","LOSARTAN POTASSIUM","TAB 25MG","90","Select","Select",""],["","50228043601","NAPROXEN","TAB 500MG","-60","Select","Select",""],["","50111045001","TRAZODONE HYDROCHLORIDE","TAB 150MG","90","Select","Select",""],["","65162044211","MECLIZINE HYDROCHLORIDE","TAB 25MG","30","Select","Select",""],["","64380073706","VITAMIN D","CAP 50000UNT","2","Select","Select",""],["","00527411737","PROPRANOLOL HYDROCHLORIDE ER","CAP 80MG ER","90","Select","Select",""],["","69784050001","EC-NAPROXEN","TAB 500MG","180","Select","Select",""],["","69315011610","FUROSEMIDE","TAB 20MG","90","Select","Select",""],["","70010006510","METFORMIN HYDROCHLORIDE","TAB 1000MG","180","Select","Select",""],["","00832532411","POTASSIUM CHLORIDE ER","TAB 10MEQ ER","90","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA","AER HFA","8","Select","Select",""],["","00904671740","CETIRIZINE HYDROCHLORIDE","TAB 10MG","90","Select","Select",""],["","00093310953","AMOXICILLIN","CAP 500MG","-30","Select","Select",""],["","68180035109","SERTRALINE HCL","TAB 25MG","-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":[]}},{"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":""}]}]}