{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"J   ETTENNADLEIFTIHW ","gend":1,"add":"NOTROM 401H TPA TS ","city":"FRANKLIN","state":"VA","zip":"23851-9998","dob":"1963-11-16","age":"","mstatus":"","insh":"94000910*620","cliId":"","pno":"2843434419","cno":"","email":"","ename":"","eno":"","pphy":"REHMANI, SAMEERAH MD","ppno":7579239600,"pcpadd":"3060 GODWIN BLVD","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":"23434-9998","pcpcounty":"","pcpid":"","pcpname":"Lakeview Pediatrics & Family Medicine","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","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":["F29.","Z12.11","E11.9","E78.5","I10.","M17.0","Z79.1","Z79.899","R30.0","R07.9","R05.9","U07.1","R50.9","M79.10","J02.9","R51.9","R19.7","J44.9","Z87.891","Z88.0","K21.9","M17.11","R10.11","K80.20"],"date":["2023-01-05","2022-07-13","2022-10-26","2022-10-26","2022-10-26","2022-07-27","2022-07-27","2022-06-17","2022-10-26","2022-01-01","2022-01-10","2022-01-10","2022-01-01","2022-01-01","2022-01-01","2022-01-01","2022-01-01","2022-01-01","2022-01-01","2022-01-01","2022-10-26","2022-09-27","2022-10-26","2022-10-26"],"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":[["","68462026390","ROSUVASTATIN","TAB 20MG","90","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","57237000905","MIRTAZAPINE","30 MG","90","Select","Select",""],["","00591046005","GLIPIZIDE","5 MG","90","Select","Select",""],["","68180097903","LISINOPRIL","40 MG","90","Select","Select",""],["","67877043103","ARIPIPRAZOLE","5 MG","90","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","15","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","00121077504","GG\/CODEINE","SOL 100-10\/5","280","Select","Select",""],["","29300012810","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","00378668977","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","53489011905","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","00591039860","DICLO\/MISOPR","TAB 75-0.2MG","30","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","00186037020","SYMBICORT","160-4.5MCG","10.2","Select","Select",""],["","68382005005","MELOXICAM","TAB 7.5MG","30","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","50383070016","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","42806040021","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","90 MCG","18","Select","Select",""],["","68462026390","ROSUVASTATIN CALCIUM","20 MG","90","Select","Select",""],["","13107000334","MIRTAZAPINE TAB","30MG","90","Select","Select",""],["","00310737020","BUDES\/FORMOT AER","160-4.5","10","Select","Select",""],["","60505082901","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","31722088490","ROSUVASTATIN TAB","20MG","90","Select","Select",""],["","68180097903","LISINOPRIL TAB","40MG","90","Select","Select",""],["","67877043103","ARIPIPRAZOLE TAB","5MG","90","Select","Select",""],["","00591046005","GLIPIZIDE TAB","5MG","90","Select","Select",""],["","00378064205","PREDNISONE TAB","20MG","15","Select","Select",""],["","00591039860","DICLO\/MISOPR TAB","75-0.2MG","30","Select","Select",""],["","68382005005","MELOXICAM TAB","7.5MG","30","Select","Select",""],["","66993001968","ALBUTEROL AER HFA","","18","Select","Select",""],["","62756007164","PANTOPRAZOLE PAK","40MG","30","Select","Select",""],["","29300012810","HYDROCHLOROT TAB","25MG","90","Select","Select",""],["","00121077504","GG\/CODEINE SOL","100-10\/5","280","Select","Select",""],["","53489011905","DOXYCYCL HYC CAP","100MG","20","Select","Select",""],["","00186037020","SYMBICORT AER","160-4.5","10","Select","Select",""],["","68180072003","AMLODIPINE TAB","5MG","30","Select","Select",""],["","00378668977","PANTOPRAZOLE TAB","40MG","30","Select","Select",""],["","42806071401","BENZONATATE","100 MG","42","Select","Select",""],["","68180072003","AMLODIPINE BESYLATE","5 MG","30","Select","Select",""],["","29300012810","HYDROCHLOROTHIAZIDE","25 MG","90","Select","Select",""],["","00378668977","PANTOPRAZOLE SODIUM","40 MG","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":""}]}]}