{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"H   SUILUJIII HTIMS ","gend":0,"add":"RAELC 7NL WEIV","city":"STAFFORD","state":"VA","zip":"22554-9998","dob":"1982-05-05","age":"","mstatus":"","insh":"43500210*70","cliId":"","pno":"48\/0458425-7","cno":"540\/847-5248","email":"","ename":"","eno":"","pphy":"ANSARI, NATHER MD","ppno":"540\/785-9900","pcpadd":"SUITE 200 4510 PLANK RD","pcpcity":"FREDERICKSBURG","pcpstate":"VA","pcpzip":22407,"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":["E86.0","R74.8","J01.40","J06.9","R51.9","Z20.828","G25.9","T43.015A","J30.0","J32.9","R05.9","H05.012","G47.00","M25.551","M25.531","R20.2","R20.0","M25.50","NO DATA","M54.5","M54.2","F25.9","F31.9","G25.89","G47.9","F41.9","F17.290","Z87.39","Z87.828","R26.89","M62.830"],"date":["2020-07-28","2020-07-28","2022-07-05","2022-07-05","2022-07-05","2022-07-05","2020-11-23","2020-11-23","2021-12-15","2021-12-15","2021-12-15","2021-11-03","2021-11-03","2020-09-24","2020-09-24","2020-09-24","2020-09-24","2022-02-19","2022-02-19","2020-11-18","2020-11-18","2020-11-18","2020-11-23","2020-11-23","2020-11-23","2020-11-23","2020-11-23","2020-11-23","2020-11-23","2020-11-23","2020-08-18"],"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":[["","59651017701","DOXEPIN","CAP 100MG","30","Select","Select",""],["","29300041519","CYCLOBENZAPR","TAB 10MG","20","Select","Select",""],["","69452014430","BENZONATATE","CAP 200MG","20","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","20","Select","Select",""],["","00069034530","PAXLOVID","TAB 300-100","30","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","10","Select","Select",""],["","42806031250","DOXYCYCL","TAB 100MG","20","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","00143928501","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","29300013501","CLONIDINE","TAB 0.1MG","60","Select","Select",""],["","69315090501","LORAZEPAM","TAB 1MG","15","Select","Select",""],["","50580022824","BENADRYL","CAP 25MG","15","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":""}]}]}