{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ORIMARAIPAT ","gend":0,"add":"ETNIW 11311DAOR KCOPR","city":"CHESTERFIELD","state":"VA","zip":"23838-9998","dob":"1979-09-22","age":"","mstatus":"","insh":"0560210*57","cliId":"","pno":"88\/4086914-2","cno":"","email":"","ename":"","eno":"","pphy":"SHAH, AMAR MD","ppno":"804\/256-8282","pcpadd":"7300 ASHLAKE PKWY STE 200","pcpcity":"CHESTERFIELD","pcpstate":"VA","pcpzip":23832,"pcpcounty":"","pcpid":"","pcpname":"VitalCare Family, LLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K21.9","K92.1","Z20.828","Z11.59","R06.83","Z71.9","R06.81","E66.9","Z20.822","G47.33","R31.21","E66.01","I10.","E78.5","E11.9","S90.862A","W57.XXXA","L02.31","M79.672","R39.198","A63.0","N48.1","L50.9","R07.89","R06.02","Z79.84"],"date":["2021-04-08","2021-03-19","2021-02-28","2020-06-06","2021-03-19","2021-04-08","2021-03-19","2022-08-22","2021-10-02","2022-07-12","2021-03-26","2022-04-04","2022-04-04","2022-04-04","2022-11-06","2022-05-16","2022-05-16","2022-10-10","2022-05-16","2022-08-22","2022-08-22","2022-08-22","2022-11-06","2022-11-06","2022-11-06","2022-11-06"],"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":{"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":[["","50111033401","METRONIDAZOL","TAB 500MG","10","Select","Select",""],["","70377002711","ATORVASTATIN","TAB 10MG","90","Select","Select",""],["","53191036201","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","53191036201","D3-50","CAP 50000UNT","4","Select","Select",""],["","68180051201","LISINOPRIL","TAB 2.5MG","90","Select","Select",""],["","00093226301","AMOXICILLIN","TAB 500MG","21","Select","Select",""],["","37000045502","PRILOSEC","TAB 20MG","90","Select","Select",""],["","70010049110","METFORMIN","TAB 500MG ER","90","Select","Select",""],["","49483048112","ASPIRIN","TAB 81MG EC","90","Select","Select",""],["","68462079817","TRIAMCINOLON","OIN 0.005","15","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","12","Select","Select",""],["","00023611803","CONDYLOX","GEL 0.005","4","Select","Select",""],["","00591320413","PODOFILOX","SOL 0.005","4","Select","Select",""],["","49483060350","IBUPROFEN","TAB 600MG","20","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","51672128902","NYSTATIN","CRE 100000","30","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","64980027903","GLIPIZIDE","TAB 2.5MG","90","Select","Select",""],["","65862039110","ONDANSETRON","TAB 8MG ODT","14","Select","Select",""],["","07610032024","MAG","TAB 400MG","30","Select","Select",""],["","51862017901","BUT\/APAP\/CAF","CAP ","18","Select","Select",""],["","52268020101","SUTAB","TAB ","24","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","49502050002","EPIPEN","INJ 0.3MG","2","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":""}]}]}