{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ADIMAHINAHG ","gend":1,"add":"SNIA 5018EVA HTROW","city":"SPRINGFIELD","state":"VA","zip":"22152-9998","dob":"1939-04-10","age":"","mstatus":"","insh":"94000910*534","cliId":"","pno":"6320257271","cno":"","email":"","ename":"","eno":"","pphy":"FEISEE, SEDDIGHEH MD","ppno":7033194161,"pcpadd":"301 MAPLE AVE W STE 420","pcpcity":"VIENNA","pcpstate":"VA","pcpzip":"22180-9998","pcpcounty":"","pcpid":"","pcpname":"SEDDIGHEH FEISEE MD PC","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":["H61.23","J06.9","I69.30","J98.11","J40.","M62.81","R26.2","R53.1","I10.","M15.0","G60.9","I69.354","M19.90","E03.9","F03.90","R41.0","R44.2","J18.9","J90.","R06.02","R07.9","M54.50","F32.A","R78.89","E75.6","R94.6","E55.9","I63.9","M06.9","I11.9","R32.","K14.0","G31.84","F34.1","R26.0","R41.3","R52.","M25.569","J20.9","I49.9","R55.","Z86.73","R63.4","R63.0","M17.0","J45.909","E78.5","Z79.82","Z79.1","Z91.81","R42.","I48.0","E78.00","N39.0","K59.00","R05.8","Z74.3","F32.9","Z79.52","Z87.39","Z71.89","Z68.31","Z74.09","Z74.1","Z74.2","Z79.899","R53.83","R07.89","Z23.","I67.9","R41.82","R90.82","Z86.79","Z86.59","I67.841","G30.0","Z00.00","E66.9","I48.91","G62.9","Z79.01","Z79.890","Z68.30","H10.33","F41.1","F33.8","I48.20","M54.9","G30.1","G45.9","R40.4","M25.562","Z96.653"],"date":["2022-02-27","2023-01-20","2022-04-28","2023-01-06","2022-04-15","2023-03-09","2023-03-09","2023-03-09","2023-03-09","2023-03-09","2022-08-31","2023-02-01","2023-02-01","2023-02-01","2023-02-01","2023-01-06","2022-02-04","2022-04-21","2022-04-21","2022-04-21","2023-01-27","2022-04-28","2022-08-16","2022-12-21","2022-12-21","2022-12-21","2022-08-10","2022-08-07","2022-12-31","2022-08-16","2022-12-21","2021-10-21","2022-04-11","2022-10-24","2023-01-07","2022-10-24","2022-06-01","2022-06-01","2022-07-14","2023-01-27","2023-01-07","2023-01-07","2022-12-05","2022-12-05","2022-08-16","2022-08-16","2022-12-31","2022-08-16","2022-08-16","2022-08-16","2022-10-02","2023-01-20","2022-10-05","2022-12-29","2022-11-11","2022-03-31","2023-01-06","2021-12-13","2022-12-31","2021-12-13","2022-12-31","2022-12-31","2022-12-31","2022-12-31","2021-12-13","2023-01-07","2022-01-12","2022-09-29","2021-12-14","2022-07-27","2023-01-07","2023-01-07","2023-01-06","2023-01-06","2023-01-07","2023-01-07","2022-12-29","2023-01-07","2023-01-07","2023-01-07","2023-01-07","2023-01-07","2023-01-07","2022-12-19","2022-12-31","2022-12-31","2022-12-31","2022-12-31","2022-10-24","2023-01-06","2023-01-07","2023-03-06","2023-03-06"],"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":[["","31722093612","OMEGA-3 ACID","ETH YL ESTERS 1 G","180","Select","Select",""],["","31722070430","VALACYCLOVIR","TAB 500MG","30","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","49483060350","IBUPROFEN","TAB 600MG","21","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","20","Select","Select",""],["","75826011510","PHENAZOPYRID","TAB 200MG","30","Select","Select",""],["","13668000805","ZOLPIDEM","TAB 10MG","90","Select","Select",""],["","69680011225","CYANOCOBALAM","INJ 1000MCG","4","Select","Select",""],["","69315012710","FOLIC ACID","1 MG","180","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","60","Select","Select",""],["","68382037001","NYSTATIN","POW 100000","45","Select","Select",""],["","50742061510","METOPROL SUC","TAB 25MG ER","180","Select","Select",""],["","68180016006","AZITHROMYCIN","250 MG","12","Select","Select",""],["","00228202950","ALPRAZOLAM","0.5 MG","30","Select","Select",""],["","00096070735","DRYSOL","SOL 0.2","35","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","44","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","00378180710","LEVOTHYROXIN","TAB 88MCG","90","Select","Select",""],["","45802046564","KETOCONAZOLE","2 %","120","Select","Select",""],["","00074659490","SYNTHROID","TAB 88MCG","90","Select","Select",""],["","24208029525","TOBRA\/DEXAME","SUS 0.3-0.1%","2","Select","Select",""],["","69452015120","VITAMIN D","2 1250 MCG","12","Select","Select",""],["","68462074617","ACYCLOVIR","OIN 0.05","45","Select","Select",""],["","00574220145","TRETINOIN","CRE 0.001","45","Select","Select",""],["","24208039830","IPRATROPIUM","SPR 0.0003","90","Select","Select",""],["","64764017130","DEXILANT","CAP 30MG DR","90","Select","Select",""],["","70436015542","PROMETHAZINE","SOL DM","240","Select","Select",""],["","27241009809","DULOXETINE","CAP 30MG","180","Select","Select",""],["","70069000701","OLOPATADINE","DRO 0.001","30","Select","Select",""],["","47335077991","AZELASTINE","SPR 0.001","90","Select","Select",""],["","69097081312","GABAPENTIN","100 MG","60","Select","Select",""],["","65162017306","MEMANTINE","TAB 5MG","180","Select","Select",""],["","65862007601","CIPROFLOXACN","TAB 250MG","30","Select","Select",""],["","69367017401","HYDROQUINONE","CRE 0.04","28","Select","Select",""],["","70377000612","ROSUVASTATIN","TAB 5MG","90","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","20","Select","Select",""],["","42806016005","HYDROXYZ HCL","TAB 25MG","90","Select","Select",""],["","33342002208","LEVOFLOXACIN","TAB 500MG","7","Select","Select",""],["","67877012485","SILVER SULFA","CRE 0.01","85","Select","Select",""],["","43547040111","FUROSEMIDE","TAB 20MG","20","Select","Select",""],["","67877025130","TRIAMCINOLON","CRE 0.001","30","Select","Select",""],["","24979070306","DEXLANSOPRAZ","CAP 30MG DR","90","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","20","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","14","Select","Select",""],["","00116200116","CHLORHEX GLU","SOL 0.0012","473","Select","Select",""],["","24208091055","ERYTHROMYCIN","OIN 5MG\/GM","4","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA","100","Select","Select",""],["","68180065208","DOXYCYC MONO","CAP 100MG","180","Select","Select",""],["","12547017162","BENADRYL","CRE 1-0.1%","57","Select","Select",""],["","49884090738","MEGESTROL AC","SUS 40MG\/ML","180","Select","Select",""],["","00121087316","LACTULOSE","10 G\/15 ML","1800","Select","Select",""],["","62559043130","HYDROCORTISO","CRE 0.025","30","Select","Select",""],["","00003089421","ELIQUIS","5 MG","90","Select","Select",""],["","00703005101","METHYLPR ACE","INJ 80MG\/ML","4","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","3","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","21","Select","Select",""],["","31722093612","OMEGA-3-ACID","CAP 1GM","180","Select","Select",""],["","00054317757","DEXAMETHASON","SOL 0.5\/5ML","10","Select","Select",""],["","76385012450","METHOCARBAM","TAB 750MG","20","Select","Select",""],["","67877021660","CEFUROXIME","TAB 500MG","14","Select","Select",""],["","00116200116","CHLORHEXIDINE GLUCONATE","0.12 %","473","Select","Select",""],["","65162017306","MEMANTINE HCL","5 MG","180","Select","Select",""],["","31722093612","OMEGA-","3 ACID ETHYL ESTERS 1 G","180","Select","Select",""],["","00574709012","HYDROCORTISONE ACETATE","25 MG","12","Select","Select",""],["","70436015542","PROMETHAZINE SOL DM","","240","Select","Select",""],["","45802046564","KETOCONAZOLE SHA","2%","120","Select","Select",""],["","49483060350","IBUPROFEN TAB","600MG","21","Select","Select",""],["","42806016005","HYDROXYZ HCL TAB","25MG","90","Select","Select",""],["","24979070306","DEXLANSOPRAZ CAP","30MG DR","90","Select","Select",""],["","43547040111","FUROSEMIDE TAB","20MG","20","Select","Select",""],["","50111033401","METRONIDAZOL TAB","500MG","60","Select","Select",""],["","00121086802","NYSTATIN SUS","100000","45","Select","Select",""],["","24208029525","TOBRA\/DEXAME SUS","0.3-0.1%","2","Select","Select",""],["","00074659490","SYNTHROID TAB","88MCG","90","Select","Select",""],["","31722070530","VALACYCLOVIR TAB","1GM","20","Select","Select",""],["","00378180710","LEVOTHYROXIN TAB","88MCG","90","Select","Select",""],["","64764017130","DEXILANT CAP","30MG DR","90","Select","Select",""],["","65862057490","MONTELUKAST TAB","10MG","90","Select","Select",""],["","47781030301","NITROFURANTN CAP","100MG","20","Select","Select",""],["","75826011510","PHENAZOPYRID TAB","200MG","30","Select","Select",""],["","50742061510","METOPROL SUC TAB","25MG ER","180","Select","Select",""],["","49884090738","MEGESTROL AC SUS","40MG\/ML","180","Select","Select",""],["","51672136307","DICLOFENAC GEL","3%","100","Select","Select",""],["","47335077991","AZELASTINE SPR","0.1%","90","Select","Select",""],["","69680011225","CYANOCOBALAM INJ","1000MCG","4","Select","Select",""],["","69315012710","FOLIC ACID TAB","1000MCG","180","Select","Select",""],["","68180016011","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","69097081312","GABAPENTIN CAP","100MG","60","Select","Select",""],["","53746017360","MEMANTINE TAB HCL","5MG","180","Select","Select",""],["","00574220145","TRETINOIN CRE","0.1%","45","Select","Select",""],["","24208039830","IPRATROPIUM SPR","0.03%","90","Select","Select",""],["","68382037001","NYSTATIN POW","100000","45","Select","Select",""],["","69452015120","VITAMIN D CAP","50000UNT","12","Select","Select",""],["","00096070735","DRYSOL SOL","20%","35","Select","Select",""],["","13668000805","ZOLPIDEM TAB","10MG","90","Select","Select",""],["","27241009809","DULOXETINE CAP","30MG","180","Select","Select",""],["","00093101042","MUPIROCIN OIN","2%","44","Select","Select",""],["","69367017401","HYDROQUINONE CRE","4%","28","Select","Select",""],["","68462074617","ACYCLOVIR OIN","5%","45","Select","Select",""],["","70069000701","OLOPATADINE DRO","0.1%","30","Select","Select",""],["","00228202950","ALPRAZOLAM TAB","0.5MG","30","Select","Select",""],["","65862007601","CIPROFLOXACN TAB","250MG","30","Select","Select",""],["","70377000612","ROSUVASTATIN TAB","5MG","90","Select","Select",""],["","51672136307","DICLOFENAC SODIUM","3 %","100","Select","Select",""],["","65862042005","SMZ\/TMP DS TAB","800-160","20","Select","Select",""],["","67877012485","SILVER SULFA CRE","1%","85","Select","Select",""],["","65862050220","AMOX\/K CLAV TAB","500-125","21","Select","Select",""],["","33342002208","LEVOFLOXACIN TAB","500MG","7","Select","Select",""],["","68462010530","ONDANSETRON TAB","4MG","14","Select","Select",""],["","68180065208","DOXYCYC MONO CAP","100MG","180","Select","Select",""],["","51672126705","TRIAMCINOLON PST DEN","0.1%","5","Select","Select",""],["","00093310905","AMOXICILLIN CAP","500MG","20","Select","Select",""],["","00121087316","LACTULOSE SOL","10GM\/15","600","Select","Select",""],["","53885024510","ONETOUCH TES ULTRA","","100","Select","Select",""],["","24208091055","ERYTHROMYCIN OIN","5MG\/GM","4","Select","Select",""],["","62559043130","HYDROCORTISO CRE","2.5%","30","Select","Select",""],["","00116200116","CHLORHEX GLU SOL","0.12%","473","Select","Select",""],["","12547017162","BENADRYL CRE","1-0.1%","57","Select","Select",""],["","00003089421","ELIQUIS TAB","5MG","180","Select","Select",""],["","00703005101","METHYLPR ACE INJ","80MG\/ML","4","Select","Select",""],["","65162017306","MEMANTINE TAB","5MG","180","Select","Select",""],["","70710113908","FLUCONAZOLE TAB","150MG","3","Select","Select",""],["","00054317757","DEXAMETHASON SOL","0.5\/5ML","10","Select","Select",""],["","67877025130","TRIAMCINOLON CRE","0.1%","30","Select","Select",""],["","64380016001","MEGESTROL ACETATE","400MG\/10ML","180","Select","Select",""],["","00378668910","PANTOPRAZOLE SODIUM","40 MG","90","Select","Select",""],["","00378180710","LEVOTHYROXINE SODIUM","88 MCG","90","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","67877021660","CEFUROXIME TAB","500MG","14","Select","Select",""],["","71930005552","ACETAMINOPHEN-CODEINE","300MG-30MG","40","Select","Select",""],["","00713022460","FLUOCINOLONE ACETONIDE","0.025 %","60","Select","Select",""],["","68180065208","DOXYCYCLINE MONOHYDRATE","100 MG","180","Select","Select",""],["","76385012450","METHOCARBAM TAB","750MG","20","Select","Select",""],["","65862057490","MONTELUKAST SODIUM","10 MG","90","Select","Select",""],["","27241009809","DULOXETINE HCL","30 MG","180","Select","Select",""],["","50428034583","GENTLE LAXATIVE","10 MG","4","Select","Select",""],["","69680011225","CYANOCOBALAMIN INJECTION","1000MCG\/ML","4","Select","Select",""],["","50742061510","METOPROLOL SUCCINATE","25 MG","180","Select","Select",""],["","70377000612","ROSUVASTATIN CALCIUM","5 MG","90","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":""}]}]}