{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  DRAHCIRRUZAM F ","gend":0,"add":"CIREDERF 2106102 TPA TS K","city":"SPRINGFIELD","state":"VA","zip":"22150-9998","dob":"1972-08-18","age":"","mstatus":"","insh":"1662210*10","cliId":"","pno":"38\/1752923-5","cno":"571\/835-3292","email":"","ename":"","eno":"","pphy":"FAROOQ, TAMKEEN DO","ppno":"703\/797-6970","pcpadd":"6355 WALKER LN STE 500","pcpcity":"ALEXANDRIA","pcpstate":"VA","pcpzip":22310,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"NORTHERN\/ WINCHESTER","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":["F31.64","F10.20","Z72.0","F31.81","F60.9","F11.20","F13.20","F14.20","F12.20","F39.","Z59.8","F41.9","F31.5","F10.21","F17.210","F20.3","E78.5","N32.81","Z20.828","F43.23","F43.20","K57.32","R42.","H61.21","H65.01"],"date":["2022-06-15","2022-06-15","2022-06-15","2021-06-07","2021-06-07","2021-06-07","2021-06-07","2021-06-07","2021-06-07","2021-06-07","2021-06-07","2021-06-07","2020-09-15","2020-09-15","2020-09-15","2020-02-03","2020-02-03","2020-02-03","2020-09-25","2021-08-04","2021-08-04","2022-09-22","2022-03-22","2022-03-22","2022-03-22"],"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":[["","55111016730","OLANZAPINE","TAB 15MG","30","Select","Select",""],["","47335032688","NALTREXONE","TAB 50MG","30","Select","Select",""],["","65862019401","FLUOXETINE","CAP 40MG","30","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","14","Select","Select",""],["","16571066101","MECLIZINE","TAB 25MG","60","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","49281042150","FLUZONE","INJ 2021-22","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":""}]}]}