{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AKNUERBNETOM ","gend":1,"add":"OB OP815 X","city":"SPOTSYLVANIA","state":"VA","zip":"22553-9998","dob":"1989-11-16","age":"","mstatus":"","insh":"34500210*33","cliId":"","pno":"72\/0452175-7","cno":"540\/277-5712","email":"","ename":"","eno":"","pphy":"PAI, DEEPA MD","ppno":"540\/710-9100","pcpadd":"422 GARRISONVILLE ROAD SUITE 102","pcpcity":"STAFFORD","pcpstate":"VA","pcpzip":22554,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","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":["J01.10","F32.3","F31.9","F28.","F31.4","F33.9","D18.02","E55.9","R30.0","R10.9","E78.2","F41.9","I10.","N30.00","NO DATA","R00.0","H92.09","Z88.0","Z88.8","R05.","J45.909","Z79.899","F32.9","R09.89","J01.90","R21.","R44.0","Z30.9","Z11.3","Z79.3","F33.1","F43.10","J45.901","Z20.828","R63.8","Z01.419","Z12.4","Z30.40","R73.03","Z68.36","N89.8","F31.32","J02.0","J45.21","Z88.2","R06.2","L20.9","L03.313","L02.213","Z87.09","Z88.1","L29.9","L03.319","L02.219","B96.89","F31.64","E66.9","L98.9","J30.9","N39.0","K59.00","J06.9","J45.30","G44.41","R20.9","R94.02","R10.84","N28.9","R94.4","K59.09","R14.0","J30.2","R63.5","E28.2","F32.81","L21.9","N92.6","F99.","F41.0","R44.3","Z00.00","F29.","Z04.6","Z91.19","Z03.818","F23.","R41.82","N92.0","Z30.09"],"date":["2020-03-06","2020-05-01","2021-06-15","2022-04-27","2021-06-28","2021-12-10","2022-03-04","2022-03-04","2022-08-24","2022-08-24","2022-08-24","2022-08-24","2022-08-24","2022-08-24","2022-08-24","2020-03-06","2020-03-06","2022-05-13","2022-05-13","2020-03-27","2022-05-13","2022-05-13","2021-08-30","2020-03-06","2020-03-08","2021-04-27","2020-04-23","2021-05-12","2022-02-21","2022-01-21","2022-06-24","2022-06-24","2020-04-17","2020-04-17","2021-06-16","2022-10-07","2022-10-07","2022-10-07","2022-04-27","2021-11-03","2022-02-21","2022-10-10","2020-04-17","2020-04-17","2022-05-13","2020-04-17","2020-05-31","2020-05-31","2020-05-31","2020-05-31","2020-05-31","2020-05-31","2020-05-31","2020-05-31","2020-05-31","2020-12-23","2021-08-30","2021-10-26","2021-08-30","2022-07-01","2022-07-27","2022-07-27","2022-07-27","2022-03-04","2022-03-04","2022-03-04","2022-10-07","2022-05-13","2022-05-13","2022-10-07","2022-10-07","2021-04-14","2021-04-14","2021-07-21","2021-07-21","2021-10-26","2022-05-31","2020-04-05","2020-04-05","2020-04-24","2020-07-29","2020-11-30","2020-11-30","2020-11-30","2020-12-18","2020-12-01","2020-04-25","2020-08-12","2020-08-12"],"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":[["","69315013601","BENZTROPINE","TAB 0.5MG","30","Select","Select",""],["","10370010150","BUPROPN","TAB 150MG XL","30","Select","Select",""],["","62756079888","DIVALPROEX","TAB 500MG DR","60","Select","Select",""],["","00555902658","JUNEL","TAB 43831","84","Select","Select",""],["","69238168101","FLUPHENAZINE","TAB 10MG","30","Select","Select",""],["","00002143480","TRULICITY","INJ 1.5\/0.5","6","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","50742061510","METOPROL","TAB 25MG ER","60","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","50428042790","MAG","SOL LEMON","295","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","69097012303","TOPIRAMATE","TAB 50MG","60","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","66993008096","FLUTICAS","AER 220MCG","12","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","7","Select","Select",""],["","16571041250","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","33342032915","TRIAMCINOLON","CRE 0.001","15","Select","Select",""],["","00173072020","FLOVENT","AER 220MCG","12","Select","Select",""],["","19515081852","FLULAVAL","INJ 2021-22","0","Select","Select",""],["","68382003616","VENLAFAXINE","CAP 150MG ER","30","Select","Select",""],["","51991029201","OXCARBAZEPIN","TAB 150MG","60","Select","Select",""],["","00093816301","QUETIAPINE","TAB 200MG","30","Select","Select",""],["","59762453701","MEDROXYPR","INJ 150MG\/ML","1","Select","Select",""],["","00430042014","LO","TAB 40452","84","Select","Select",""],["","54879000460","BETAMETH","LOT 0.001","60","Select","Select",""],["","51672135008","CLOBETASOL","LOT 0.0005","118","Select","Select",""],["","71428000160","FLUOCINONIDE","SOL 0.0005","60","Select","Select",""],["","53191036201","D3-50","CAP 50000UNT","4","Select","Select",""],["","50111045001","TRAZODONE","TAB 150MG","30","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00054001829","PREDNISONE","TAB 20MG","15","Select","Select",""],["","53489011905","DOXYCYCL","CAP 100MG","28","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","30","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","73796045801","COMP","MIS COMP\/NEB","1","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","23155050110","HYDROXYZ","TAB 25MG","30","Select","Select",""],["","59779065034","TUSSIN","LIQ 100\/5ML","120","Select","Select",""],["","43547030303","ARIPIPRAZOLE","TAB 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":""}]}]}