{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"S   ODNICREMUGZAID ZEUQIRNE ","gend":0,"add":"DR HT8 1015602 TPA S ","city":"ARLINGTON","state":"VA","zip":"22204-9998","dob":"1956-01-17","age":"","mstatus":"","insh":"35600210*20","cliId":"","pno":"26\/3077665-6","cno":"703\/626-5667","email":"","ename":"","eno":"","pphy":"GAMI, YEMSRACH MD","ppno":"703\/933-8111","pcpadd":"1800 N BEAUREGARD ST STE 100","pcpcity":"ALEXANDRIA","pcpstate":"VA","pcpzip":22311,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","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":["R20.2","S06.5X9A","I69.334","G40.909","G06.2","Z98.890","R29.898","Z48.811","A49.8","H11.053","E11.9","H43.813","H52.7","G40.319","G31.9","G40.209","R56.9","R22.43","I62.03","Z12.11","Z23.","E11.59","Z79.4","M25.561","E78.2","N40.0","K21.9","M79.604","G89.29","M79.605","H11.003","H25.13","E11.65","N40.1","M25.512","M17.11","E66.3","R60.0","K59.00","R39.12","Z11.59","R35.0","N52.9","K29.00","R10.13","R51.9"],"date":["2020-04-30","2020-04-30","2020-11-03","2022-07-26","2020-11-03","2020-04-30","2020-04-30","2020-04-30","2020-04-30","2021-03-30","2022-04-04","2022-04-04","2022-04-04","2021-08-26","2022-01-06","2021-08-26","2022-06-21","2022-04-01","2020-06-11","2021-09-27","2021-09-27","2022-07-26","2022-07-26","2022-04-01","2022-07-26","2022-03-22","2022-03-22","2022-04-01","2022-04-01","2022-04-01","2022-04-04","2022-04-04","2022-07-26","2022-07-26","2022-07-26","2022-07-26","2022-07-26","2022-07-26","2022-07-26","2022-07-26","2021-07-26","2021-05-21","2021-06-24","2022-09-12","2022-09-12","2022-09-12"],"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":[["","68382076010","METFORMIN","TAB 1000MG","180","Select","Select",""],["","00469260130","MYRBETRIQ","TAB 25MG","90","Select","Select",""],["","08290320109","BD  PEN NEEDL","MIS 31GX8MM","100","Select","Select",""],["","00131248035","VIMPAT","TAB 200MG","180","Select","Select",""],["","62756079713","DIVALPROEX","TAB 250MG DR","540","Select","Select",""],["","70377002911","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","00603020922","MAG","TAB 400MG","30","Select","Select",""],["","65862024708","LEVETIRACETA","TAB 750MG","360","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","65862014990","FINASTERIDE","TAB 5MG","90","Select","Select",""],["","57237001401","TAMSULOSIN","CAP 0.4MG","90","Select","Select",""],["","00955172805","INSULIN","INJ 100U\/ML","15","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","15","Select","Select",""],["","68462068160","LACOSAMIDE","TAB 200MG","12","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","400","Select","Select",""],["","00093301856","TADALAFIL","TAB 10MG","20","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","1","Select","Select",""],["","53885013610","ONETOUCH","MIS LANCETS","100","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","00093534156","SILDENAFIL","TAB 25MG","20","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","30","Select","Select",""],["","50428085942","PREP","PAD ","100","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}