{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"P YCARTNOSRAE","gend":0,"add":"RTREMMUS 13711A TPA RIC ECA","city":"RESTON","state":"VA","zip":"20194-9998","dob":"1969-10-23","age":"","mstatus":"","insh":"28600210*92","cliId":"","pno":"54\/3070632-4","cno":"703\/454-2360","email":"","ename":"","eno":"","pphy":"CHOI-BLANCO, JENNIFER MD","ppno":"703\/938-7800","pcpadd":"130 PARK ST SE STE 200","pcpcity":"VIENNA","pcpstate":"VA","pcpzip":22180,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"","aligned":"","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":["C01.","E43.","J81.0","D62.","F10.232","Z68.1","G89.18","E83.51","E83.42","E87.6","E83.39","D72.829","R35.0","R59.9","R13.10","I10.","L89.152","E11.9","G47.33","G40.909","F10.10","D69.6","F10.231","Z48.3","Z48.01","Z43.0","Z43.1","L89.153","NO DATA","Z93.0","S01.512A","C06.9","Z72.0","S72.001A","W19.XXXA","S72.91XA","J96.90","R09.2","S72.144A","S01.81XA","R58.","Z74.3","F10.239","I48.91","N17.0","E87.1","E87.2","R65.20","G93.41","J13.","R65.21","D68.9","J69.0","E16.2","K80.20","I15.9","G40.89","M62.84","R78.81","E11.649","E11.40","K12.1","L08.9","Z51.5","G89.3","R11.2","R63.0","C10.9","E44.0","R42.","R61.","Z79.4","Z79.84","Z85.819","T81.30XA","L02.91","J18.9","R45.1","M86.9","R56.9","R25.1","F10.129","Z91.19","R00.0","F10.20","E87.8","R74.01","N17.9","A41.9","K76.9","R26.9","Z78.9","R41.841","F17.200","Z79.82","C04.8","C02.8","I44.0","R91.1","I71.6","R59.0","R04.1","G40.409","Z45.2","K12.2","R68.84","R29.818","D69.59","D53.9","A40.3","R73.09","K14.0","R47.02","Z46.82","Z01.818","M62.81","R26.2","Z91.81","R22.1","Z63.8","I49.3","S72.141A","G40.509","K70.10","V72.85","I21.29","R94.31","K74.60","R53.1","Z93.1","T88.9XXA","T81.40XA","T81.31XA","L50.9","R21.","T78.40XA","K22.9","E51.9","R16.0","Z71.6","L02.11","K14.8","K12.30","R13.12","R89.2","E11.69","L89.112","S90.112A","L03.032","G40.309","Z48.02","Y90.9","R11.10","K81.0","G93.40","A49.1","I48.0","Z20.822","E87.0","J47.0","K80.00","K92.0","I49.1","I45.9","Z53.21","J96.00","J96.01","B96.5","C02.9","K94.29","D69.3","F41.9","Z91.14","G40.919","D49.0","F10.229","F12.90","C44.92","I71.4","E11.65","E86.0","Z99.89","Z04.9","R52.","Z98.890","C79.89","R40.1","W18.30XA"],"date":["2022-09-19","2022-09-19","2022-05-11","2022-10-10","2022-05-11","2022-05-11","2022-05-15","2022-05-11","2022-05-11","2022-05-11","2022-05-11","2022-05-11","2022-05-11","2022-05-11","2022-09-19","2022-10-03","2022-05-11","2022-10-23","2022-09-19","2022-10-08","2022-09-01","2022-07-20","2022-05-18","2022-09-19","2022-07-20","2022-09-19","2022-09-19","2022-07-20","2022-09-19","2022-08-18","2022-08-18","2022-09-01","2022-09-19","2022-10-14","2022-11-11","2022-10-10","2022-10-10","2022-10-14","2022-11-11","2020-12-20","2020-12-20","2022-09-25","2022-09-26","2021-05-14","2021-05-10","2022-03-16","2021-05-10","2021-05-10","2021-05-13","2021-05-13","2021-05-14","2021-05-13","2021-05-14","2022-04-02","2022-08-03","2021-05-14","2022-10-23","2021-05-14","2021-05-14","2022-04-02","2022-08-29","2022-02-23","2022-02-20","2022-03-14","2022-03-14","2022-08-02","2022-03-14","2022-03-14","2022-03-15","2022-04-02","2022-04-02","2022-08-29","2022-08-29","2022-08-02","2022-06-28","2022-08-29","2022-10-09","2022-10-06","2022-10-06","2022-09-27","2020-08-28","2022-02-16","2021-04-28","2022-09-25","2021-04-28","2021-04-28","2022-08-02","2022-11-04","2022-06-04","2021-05-01","2021-05-12","2021-05-12","2021-05-12","2022-08-29","2021-11-30","2022-02-18","2022-02-18","2022-08-02","2022-03-11","2022-03-11","2022-03-11","2022-03-16","2022-09-26","2022-11-04","2021-12-09","2021-12-09","2020-11-04","2021-02-14","2021-02-14","2021-05-03","2021-11-30","2022-02-22","2022-03-16","2022-11-02","2022-04-28","2022-06-20","2022-06-20","2022-06-20","2022-08-29","2022-08-29","2022-09-25","2022-09-27","2020-08-28","2020-08-28","2020-08-28","2021-02-14","2021-02-14","2021-04-22","2022-02-16","2022-08-02","2022-06-04","2022-06-04","2022-06-04","2022-07-25","2022-07-25","2022-07-25","2022-08-02","2022-08-02","2022-08-02","2022-08-02","2022-09-01","2022-02-18","2022-02-18","2022-02-18","2022-02-18","2022-08-24","2022-08-24","2020-12-11","2020-12-11","2020-12-11","2020-12-26","2021-04-21","2021-04-21","2021-04-30","2021-05-01","2021-05-01","2021-10-18","2022-06-04","2021-04-21","2021-04-21","2021-04-21","2021-04-21","2021-04-21","2021-04-21","2022-07-25","2022-10-02","2022-10-03","2022-10-03","2022-10-03","2022-11-08","2020-08-28","2020-11-04","2020-11-04","2020-11-04","2022-02-19","2022-03-16","2022-03-16","2022-03-16","2022-03-16","2022-03-16","2022-03-16","2022-04-02","2022-05-15","2022-06-04","2022-06-28","2022-07-05","2022-09-25","2022-10-22"],"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":[["","00904515460","GUAIFENESIN","TAB 200MG","30","Select","Select",""],["","62559015116","OXYCODONE","SOL 5MG\/5ML","80","Select","Select",""],["","51672411101","PHENYTOIN","CAP 100MG","60","Select","Select",""],["","42192061916","NAPROXEN","SUS 125\/5ML","400","Select","Select",""],["","10006073038","MAG","TAB 400MG","30","Select","Select",""],["","46287000660","SPS","SUS 15GM\/60","60","Select","Select",""],["","00591350904","CLONIDINE","DIS 0.2\/24HR","4","Select","Select",""],["","62037056001","POT  CHLORIDE","CAP 10MEQ ER","14","Select","Select",""],["","16714047801","AMOX\/K","TAB 875-125","20","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","16714066101","GABAPENTIN","CAP 100MG","60","Select","Select",""],["","70010006301","METFORMIN","TAB 500MG","60","Select","Select",""],["","00536589688","NICOTINE","DIS 21MG\/24H","14","Select","Select",""],["","16714023501","PENICILLN","TAB 500MG","27","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA","100","Select","Select",""],["","69097012805","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","00781717612","NALOXONE","SPR 4MG","2","Select","Select",""],["","00527600274","LIDOCAINE","SOL 2% VISC","100","Select","Select",""],["","54838011680","SILACE","LIQ 10MG\/ML","100","Select","Select",""],["","69367032316","ACETAMIN","LIQ 160\/5ML","400","Select","Select",""],["","51079030630","POLYETH","POW 3350 NF","30","Select","Select",""],["","00002821501","HUMULIN","INJ U-100","10","Select","Select",""],["","65862018730","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","00121072208","SENNA","SYP ","200","Select","Select",""],["","16714029904","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","62332011291","METOPROL","TAB 25MG","60","Select","Select",""],["","65162046550","IBUPROFEN","TAB 600MG","20","Select","Select",""],["","11534016501","FOLIC","TAB 1MG","14","Select","Select",""],["","60569049412","MAGOX","TAB 400MG","60","Select","Select",""],["","08290328438","INSULIN","MIS 0.3\/31G","30","Select","Select",""],["","00536130485","DOCUSATE","LIQ 50MG\/5ML","100","Select","Select",""],["","51672131200","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","00378064210","PREDNISONE","TAB 20MG","15","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","68180065701","DOXYCYCLINE","SUS 25MG\/5ML","300","Select","Select",""],["","69315090601","LORAZEPAM","TAB 2MG","60","Select","Select",""],["","50742050504","SCOPOLAMINE","DIS 1MG\/3DAY","4","Select","Select",""],["","50090040300","NOVOLIN","INJ 70\/30","30","Select","Select",""],["","00781323863","ENOXAPARIN","INJ 30\/0.3ML","3","Select","Select",""],["","00223176001","SOD","TAB 1GM","100","Select","Select",""],["","50111056101","TRAZODONE","TAB 100MG","30","Select","Select",""],["","82089010234","CATAPRES-TTS","DIS 0.2\/24HR","4","Select","Select",""],["","43292050022","ACIDOPHILUS","CAP ","100","Select","Select",""],["","16729014501","QUETIAPINE","TAB 25MG","90","Select","Select",""],["","10006073021","VITAMIN","TAB 100MG","30","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","30","Select","Select",""],["","51862024030","AMIODARONE","TAB 100MG","30","Select","Select",""],["","16714035501","LEVETIRACETA","TAB 500MG","60","Select","Select",""],["","00597014030","TRADJENTA","TAB 5MG","30","Select","Select",""],["","43547040211","FUROSEMIDE","TAB 40MG","1","Select","Select",""],["","00187079530","CARDIZEM","CAP 120MG\/24","30","Select","Select",""],["","50742024890","DILTIAZEM","CAP 120MG ER","30","Select","Select",""],["","00536123441","ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","11845005651","B-1","TAB 100MG","14","Select","Select",""],["","00169368512","NOVOLOG","INJ 70\/30","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":""}]}]}