{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  AKIHDARHGNIS R ","gend":1,"add":"FENOTS 909EN QS DLEI","city":"LEESBURG","state":"VA","zip":"20176-9998","dob":"1979-11-03","age":"","mstatus":"","insh":"9111210*48","cliId":"","pno":"54\/1754411-7","cno":"","email":"","ename":"","eno":"","pphy":"ABEDIN, TAREQ MD","ppno":"703\/729-9220","pcpadd":"19415 DEERFIELD AVE","pcpcity":"LEESBURG","pcpstate":"VA","pcpzip":20176,"pcpcounty":"","pcpid":"","pcpname":"LOUDOUN MEDICAL GROUP PC","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":["Z20.828","R11.0","N64.4","K08.89","R07.9","D72.828","M94.0","R07.89","K11.21","R68.84","H92.02","F41.9","R42.","N89.8","I10.","R93.89","J02.9","E78.00","R13.13","R10.84","R30.0","K76.0","N73.9","M25.562","M23.8X2","G89.4","M25.521","L70.0","L03.211","A49.01"],"date":["2020-12-03","2020-09-07","2020-09-06","2020-09-06","2021-04-28","2020-12-03","2020-12-25","2020-12-25","2020-06-02","2020-06-02","2020-06-02","2020-06-02","2020-09-07","2020-09-07","2021-04-28","2021-04-28","2020-10-01","2020-10-01","2020-10-01","2021-11-23","2021-11-23","2021-11-23","2020-02-11","2019-02-06","2019-02-05","2019-02-06","2019-02-06","2019-02-26","2019-02-26","2019-02-26"],"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":[["","65862051601","NAPROXEN","TAB 550MG","10","Select","Select",""],["","","ATORVASTATIN","TAB 20MG","","Select","Select",""],["","43547033510","BENAZEPRIL","TAB 5MG","30","Select","Select",""],["","00832046515","NYAMYC","POW 100000","15","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","5","Select","Select",""],["","61269073607","MICONAZOLE","SUP 100MG","7","Select","Select",""],["","","HYDROXYZ","TAB 25MG","","Select","Select",""],["","","PROAIR","AER ","","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","21","Select","Select",""],["","69097084615","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","10","Select","Select",""],["","","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","","AMOX\/K","TAB 500-125","","Select","Select",""],["","","IBUPROFEN","TAB 600MG","","Select","Select",""],["","","DOXYCYCL","TAB 100MG","","Select","Select",""],["","","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","","LEVOFLOXACIN","TAB 500MG","","Select","Select",""],["","","NITROFURANTN","CAP 100MG","","Select","Select",""],["","63304069201","CLINDAMYCIN","CAP 150MG","120","Select","Select",""],["","00004080085","TAMIFLU","CAP 75MG","10","Select","Select",""],["","00378247401","DICLOFEN","TAB 50MG","21","Select","Select",""],["","69097015907","MELOXICAM","TAB 15MG","30","Select","Select",""],["","51672131200","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","53746027205","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","68180067711","OSELTAMIVIR","CAP 75MG","10","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":""}]}]}