{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   IJICGNUOY C","gend":1,"add":"TS AZALP E 57203E TPA EN ","city":"LEESBURG","state":"VA","zip":"20176-9998","dob":"1984-03-06","age":"","mstatus":"","insh":"3503210*90","cliId":"","pno":"88\/1060198-2","cno":"","email":"","ename":"","eno":"","pphy":"VARMA, SOHAN R MD","ppno":"703\/436-9969","pcpadd":"4229 LAFAYETTE CENTER DR STE 1125B-","pcpcity":"CHANTILLY","pcpstate":"VA","pcpzip":20151,"pcpcounty":"","pcpid":"","pcpname":"WASHINGTON INTERNAL MEDICINE INC","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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E86.0","R51.9","R31.29","R10.10","Z04.9","R00.2","G89.29","M25.562","M94.262","K92.2","K21.9","K29.70","F17.290","NO DATA","N20.9","N93.8","M17.12","R10.11","R11.2","F17.200","K92.0","R10.12","K31.811","Z20.822","K29.50","K31.819","F12.90","K44.9","Z87.892","Z90.49","Z88.6","Z88.8","Z91.013","R10.9","Z20.828","K29.71","I24.8","E66.9","F17.210","K76.0","Z68.32","W19.XXXS","V89.2XXS","Z71.9","Z76.89","E87.6","F11.29","F11.23","F41.9","S16.1XXA","R10.30","Z87.891","R19.5","R07.0","G43.001","R77.8","K29.80","K29.60","K20.80","R11.0","F11.20","M77.41","M25.462","S83.8X2A","V58.89","R74.8","S09.90XA","S39.012A","R68.83","R61.","R25.1","S79.912A","S89.92XA","S83.92XA","S30.0XXA","W10.8XXA","M54.5","M25.552","Z00.00","K22.8","Z11.52","R06.02","R10.13","R03.0","M25.511","R07.82","M25.561","B34.9","E83.42","E83.51","R07.89","E87.1","R00.1","N20.0","K31.84","R10.84","S93.602A","S93.402A"],"date":["2021-12-18","2021-12-06","2022-08-24","2022-06-03","2021-08-23","2021-09-26","2021-12-16","2021-12-06","2021-10-18","2021-08-26","2021-12-30","2021-11-13","2021-08-23","2021-12-06","2020-11-07","2021-01-14","2021-05-17","2021-07-01","2021-11-12","2021-12-16","2022-01-03","2021-11-13","2021-12-09","2021-12-09","2021-12-09","2021-12-09","2021-12-09","2021-12-09","2021-12-09","2022-06-03","2021-12-09","2021-12-09","2021-12-09","2022-08-24","2020-10-24","2021-05-09","2021-05-09","2021-05-11","2022-07-28","2021-05-11","2021-05-09","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-08-26","2021-09-25","2021-09-26","2021-12-06","2021-12-06","2021-12-16","2022-01-03","2021-12-30","2020-10-24","2020-12-10","2021-05-11","2021-05-10","2021-05-10","2021-05-10","2022-06-03","2021-10-14","2021-10-18","2021-02-15","2021-01-26","2021-02-15","2021-05-10","2021-06-29","2021-06-29","2021-09-26","2021-09-26","2021-09-26","2020-12-20","2020-12-20","2020-12-20","2020-12-20","2021-01-04","2021-01-04","2021-01-04","2021-06-21","2021-06-21","2021-08-02","2021-08-21","2022-07-13","2021-12-19","2020-06-21","2020-06-21","2020-06-21","2021-08-02","2021-12-18","2021-12-18","2022-06-03","2022-06-03","2022-06-03","2022-08-12","2022-07-13","2022-06-03","2022-05-17","2022-05-17"],"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":[["","","OXYCOD\/APAP","TAB 5-325MG","","Select","Select",""],["","13668042990","PANTOPRAZOLE","TAB 40MG","60","Select","Select",""],["","","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","00781717612","NALOXONE","SPR ","2","Select","Select",""],["","","PROMETHAZINE","TAB 25MG","","Select","Select",""],["","","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","65862019105","CYCLOBENZAPR","TAB 10MG","6","Select","Select",""],["","65862050220","AMOX\/K","TAB 500-125","15","Select","Select",""],["","00093221001","SUCRALFATE","TAB 1GM","52","Select","Select",""],["","","TAMSULOSIN","CAP 0.4MG","","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","","TRAMADOL","TAB 50MG","","Select","Select",""],["","00378967130","IPRATROPIUM\/","SOL ALBUTER","90","Select","Select",""],["","12496120803","SUBOXONE","MIS 8-2MG","7","Select","Select",""],["","13107005999","APAP\/CODEINE","TAB 300-30MG","6","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","15","Select","Select",""],["","00536589588","NICOTINE","DIS 14MG\/24H","14","Select","Select",""],["","29300016915","TIZANIDINE","TAB 4MG","30","Select","Select",""],["","47781035703","BUPREN\/NALOX","MIS 8-2MG","7","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","73796045801","COMP","MIS COMP\/NEB","1","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","70954006020","PREDNISONE","TAB 20MG","9","Select","Select",""],["","50428063305","CVS","SUS ANTI-GAS","355","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","00555032302","HYDROXYZ","CAP 25MG","12","Select","Select",""],["","00054023525","MORPHINE","TAB 15MG","6","Select","Select",""],["","43199001101","HYOSCYAMINE","SUB 0.125MG","20","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","","LIDOCAINE","PAD 0.05","","Select","Select",""],["","","PAIN","TAB 325MG","","Select","Select",""],["","","CEFDINIR","CAP 300MG","","Select","Select",""],["","","KETOROLAC","TAB 10MG","","Select","Select",""],["","","IBUPROFEN","TAB 800MG","","Select","Select",""],["","","BUT\/APAP\/CAF","CAP ","","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":""}]}]}