{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HAIFORGNAEP ","gend":1,"add":"AP ERTNEC 90921802 TPA RIC KR","city":"HERNDON","state":"VA","zip":"20171-9998","dob":"1956-02-06","age":"","mstatus":"","insh":"64000910*892","cliId":"","pno":"12\/1758236-8","cno":"","email":"","ename":"","eno":"","pphy":"IMAM, SHAMIM A MD","ppno":"703\/471-0850","pcpadd":"504 ELDEN STREET STE 3","pcpcity":"HERNDON","pcpstate":"VA","pcpzip":20170,"pcpcounty":"","pcpid":"","pcpname":"DULLES FAMILY MEDICINE PC","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"N","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":["R10.9","M25.561","R53.1","R20.0","R53.83","F34.1","E78.5","Z12.11","E07.9","E04.1","E05.90","E55.9","E78.2","K59.00","K21.9","Z00.01","Z13.29","Z12.31","J00.","R05.9","R03.0","Z01.419","R00.0","Z01.818","H25.042","H26.9","F41.9","G47.9","Z83.49","F41.1","Z79.899","Z71.89","Z87.39","F33.9","Z68.28","Z01.30","H25.13","H40.023","H02.831","H02.834","H25.041","F41.0","Z01.810","H25.099","H25.12","Z78.0"],"date":["2021-08-17","2021-08-17","2021-08-17","2021-08-17","2021-08-17","2022-11-22","2022-11-22","2022-07-13","2022-03-29","2022-10-17","2022-05-10","2022-05-10","2022-05-10","2022-10-17","2022-10-17","2022-10-17","2021-10-18","2022-11-21","2022-11-22","2022-11-22","2022-11-22","2021-11-29","2022-10-17","2022-06-28","2022-09-12","2022-09-12","2022-10-17","2022-10-17","2022-06-28","2022-03-29","2022-03-29","2022-03-29","2022-03-29","2022-03-29","2022-03-29","2022-03-29","2022-06-08","2022-08-17","2022-08-17","2022-08-17","2022-07-11","2022-07-11","2022-06-28","2022-06-28","2022-08-17","2022-11-21"],"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":[["","51991074890","DULOXETINE","CAP 60MG","180","Select","Select",""],["","68382024916","ATORVASTATIN","TAB 10MG","90","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","13668042990","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","45802048678","DOCUSATE SOD","CAP 100MG","100","Select","Select",""],["","70461012103","FLUAD QUADRI","INJ 2021-22","0","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","59267102504","PFIZER VACC","INJ ADLT RTU","0","Select","Select",""],["","00005200010","PREVNAR 20","INJ ","0","Select","Select",""],["","00781713593","MOXIFLOXACIN","SOL HCL 0.5%","3","Select","Select",""],["","60758011905","PREDNISOLONE","SUS 1% OP","5","Select","Select",""],["","17478010212","TROPICAMIDE","SOL 1% OP","15","Select","Select",""],["","47335022090","KETOROLAC","SOL 0.005","5","Select","Select",""],["","49281012265","FLUZONE HD","INJ 2022-23","1","Select","Select",""],["","59267030402","PFIZER BIVAL","INJ BA4\/BA5","0","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":""}]}]}