{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" INAFETSTSOP L  ","gend":1,"add":" YENOH 1663DAOR HCNARB","city":"SAINT PAUL","state":"VA","zip":"24283-9998","dob":"1969-11-28","age":"","mstatus":"","insh":"25400210*71","cliId":"","pno":"93\/6727481-5","cno":"","email":"","ename":"","eno":"","pphy":"YOUSUF, SAMINA MD","ppno":"276\/889-0433","pcpadd":"142 HIGHLANDS DR","pcpcity":"LEBANON","pcpstate":"VA","pcpzip":24266,"pcpcounty":"","pcpid":"","pcpname":"SAMINA YOUSUF MD PC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"SOUTHWEST","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":["I10.","M79.672","E55.9","F41.1","E53.8","M41.24","F51.01","M54.5","Z13.83","E53.9","G80.9","J30.9","M25.475","F34.1","Z79.899","E03.9","S92.515A","K59.00","E66.9","Z68.33","R06.02","J06.9","E78.2","M54.42","F33.41"],"date":["2020-11-18","2020-07-01","2020-07-29","2022-02-10","2020-05-06","2020-05-06","2022-02-10","2020-12-16","2022-02-10","2020-07-29","2020-08-26","2020-08-26","2020-05-04","2020-11-18","2022-04-18","2020-10-21","2020-05-04","2019-12-17","2019-05-08","2019-05-08","2019-12-28","2019-12-28","2022-02-10","2022-02-10","2022-02-10"],"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":[["","00904671772","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","","CYANOCOBALAM","INJ 1000MCG","","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","53746014501","HYDROCOD\/IBU","TAB 7.5-200","40","Select","Select",""],["","51991070610","ALPRAZOLAM","TAB 1MG","60","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","30","Select","Select",""],["","68462026290","ROSUVASTATIN","TAB 10MG","90","Select","Select",""],["","69238207707","PROPRANOLOL","TAB 10MG","30","Select","Select",""],["","62559025101","ETODOLAC","CAP 300MG","60","Select","Select",""],["","57237000805","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","","TIZANIDINE","TAB 4MG","","Select","Select",""],["","64380073706","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","14539067505","HYDROXYZ","CAP 50MG","15","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","13107002001","HYDROCO\/APAP","TAB 7.5-325","14","Select","Select",""],["","33332042110","AFLURIA","INJ 2021-22","0","Select","Select",""],["","16729020216","BUSPIRONE","TAB 10MG","30","Select","Select",""],["","69097084615","CYCLOBENZAPR","TAB 10MG","60","Select","Select",""],["","","IBUPROFEN","TAB 600MG","","Select","Select",""],["","","TRAMADOL","TAB 50MG","","Select","Select",""],["","","SHINGRIX","INJ 50\/0.5ML","","Select","Select",""],["","","FLUCLVX","INJ 2020-21","","Select","Select",""],["","13668000701","ZOLPIDEM","TAB 5MG","5","Select","Select",""],["","00172409680","BACLOFEN","TAB 10MG","4","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","60","Select","Select",""],["","10702002901","PHENTERMINE","CAP 37.5MG","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":""}]}]}