{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" NERUALKCOCNAH","gend":1,"add":"IR 10311DAOR REV","city":"CHESTERFIELD","state":"VA","zip":"23838-9998","dob":"1983-06-27","age":"","mstatus":"","insh":"7446110*79","cliId":"","pno":"33\/4080405-8","cno":"","email":"","ename":"","eno":"","pphy":"HAFFIZULLA, HOPE MD","ppno":"804\/256-8282","pcpadd":"7300 ASHLAKE PKWY STE 200","pcpcity":"CHESTERFIELD","pcpstate":"VA","pcpzip":23832,"pcpcounty":"","pcpid":"","pcpname":"SOUTHSIDE PHYSICIANS NETWORK - FAMILY MEDICINE","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","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":["K04.7","Z79.899","F90.0","F33.1","F90.2","Z63.8","L30.8","H02.63","F33.41","Z13.220","E66.01","Z13.29","H02.66","Z13.228","Z13.0","Z68.37","N92.1","K21.9","F41.1","Z20.828","R10.33","Z30.42","Z32.02","K62.5","T83.89XA","Z30.432","R10.2","Z00.00","K21.0","Q68.2","Z86.010","N39.0","R76.8","Z63.0","F43.25","M54.5","M54.31","M51.36","M54.32","J20.9","M54.40","R50.9","B34.9","L30.9","F43.20","R68.84","K02.9"],"date":["2021-03-22","2021-06-09","2020-05-28","2021-03-03","2021-06-09","2021-06-09","2020-09-15","2020-09-15","2020-09-15","2020-09-15","2020-09-15","2020-09-15","2020-09-15","2020-09-15","2020-09-15","2021-06-09","2021-01-08","2021-06-09","2021-06-09","2021-02-23","2019-03-03","2019-09-11","2019-03-04","2019-03-02","2019-03-04","2019-03-04","2019-03-04","2019-07-03","2019-07-03","2019-07-03","2019-07-03","2019-07-03","2019-07-03","2019-03-28","2019-05-08","2019-11-12","2019-11-12","2019-11-12","2019-11-12","2019-09-24","2019-12-04","2019-12-18","2019-12-18","2019-09-11","2022-05-04","2022-10-21","2022-10-21"],"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":[["","00378001805","METOPROL","TAB 25MG","60","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","14","Select","Select",""],["","00555097402","AMPHET\/DEXTR","TAB 30MG","60","Select","Select",""],["","00172572960","FAMOTIDINE","TAB 40MG","30","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","16","Select","Select",""],["","59762453802","MEDROXYPR","INJ 150MG\/ML","1","Select","Select",""],["","00093005301","BUSPIRONE","TAB 5MG","90","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","20","Select","Select",""],["","00093117410","PENICILLN","TAB 500MG","40","Select","Select",""],["","69238126601","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","15","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","30","Select","Select",""],["","00173071920","FLOVENT","AER 110MCG","12","Select","Select",""],["","","FLUOXETINE","CAP 20MG","","Select","Select",""],["","","ADDERALL","TAB 30MG","","Select","Select",""],["","00054001829","PREDNISONE","TAB 20MG","18","Select","Select",""],["","68382050010","OMEPRAZOLE","CAP 40MG","90","Select","Select",""],["","47781091601","DEXAMETHASON","TAB 6MG","5","Select","Select",""],["","10631000830","KAPSPARGO","CAP 25MG","30","Select","Select",""],["","00603158654","PROMETHAZINE","SYP DM","50","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","","BUPROPION","TAB 100MG SR","","Select","Select",""],["","69543025216","VIRTUSSIN","SOL 100-10\/5","120","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00781577626","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","70710145601","CLOBETASOL","CRE 0.0005","15","Select","Select",""],["","51672131601","ALCLOMETASON","OIN 0.0005","15","Select","Select",""],["","55111012701","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","29300012510","MELOXICAM","TAB 15MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","30","Select","Select",""],["","65162003311","APAP\/CODEINE","TAB 300-30MG","10","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","15","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","16","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":""}]}]}