{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DAWN AHMED","gend":1,"add":"12104 ASHLEIGH PARK BOULEVARD","city":"FREDERICKSBURG","state":"VA","zip":"22407-7363","dob":"1966-09-28","age":"","mstatus":"","insh":"4308091","cliId":"","pno":"5408481647","cno":"","email":"","ename":"","eno":"","pphy":"ANSARI, NATHER B","ppno":"5407859900          ","pcpadd":"1075 GARRISONVILLE RD, Ste 115","pcpcity":"STAFFORD","pcpstate":"VA","pcpzip":"225568600","pcpcounty":"","pcpid":"","pcpname":"PRIMARY AND URGENT CARE LLC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"12104 ASHLEIGH PARK BOULEVARD","madd2":"","madd3":"","mcity":"FREDERICKSBURG","mstate":"VA","mzip":"22407-7363","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F90.9","F33.9","J06.9","J01.90","R05","M25.561","E03.9","E55.9","E11.9","E10.42","E78.5","E66.01","M62.830","N30.00","I10","I63.9","E78.2","I87.2","F48.9","E03.8","Z79.899","R60.0","M79.604","M79.605","L71.8","D23.5","B36.0","L20.84","L57.0","M25.562","R41.3","E56.9","E78.49","E11.65","Q82.0","I73.9","M79.629","G45.8","I69.320","E10.8","Z03.818","J01.40","R92.1","Z85.3","R41.89","G47.33","F09","E10.65","M25.511","Z68.41","M25.512","N60.32","N60.22","N64.89","N60.39","E10.40","E06.3","M75.51","M75.02","M75.01","M75.52","G43.709","R06.00","Z20.828","G44.1","R53.83","R06.83","I49.3","E10.9","M79.606","M79.671","M79.672","L03.114","L20.9","N32.81","W57.XXXA","R51.9","S09.90XA","S06.0X0A","G44.319","R11.0","W19.XXXA","G44.309","X58.XXXA","Y92.89","Y93.89","W01.10XA","Y93.01","Y92.002","R40.2362","R40.2142","R40.2252","Z86.73","Z83.3","R07.89","R07.9","R06.02","E78.00","R79.89","F41.9","F33.42","Z91.19","R79.1","M25.539","R42","T14.90XA","Z45.2","I25.10","I27.20","I11.0","I50.30","R06.09","Z79.82","Z79.4","Z88.0","E10.51","E66.9","Z79.02","Z79.84","R10.32","R10.30","L02.214","T81.49XA","Z68.42","Z95.5","Z82.49","R60.9","L53.9","N30.80","M54.32","M54.16","R29.6","M54.42","M54.9","R73.9","U07.1","N17.9","B37.0","E10.43","J15.9","E10.649","E86.0","J12.82","R47.81","R22.1","R49.0","G47.30","J18.9","R41.0"],"date":["2022-03-31","2022-03-31","2020-01-23","2020-01-23","2020-01-23","2020-01-23","2022-03-19","2020-01-23","2022-03-04","2021-12-21","2022-01-21","2022-03-19","2020-02-22","2020-02-22","2022-03-26","2022-01-21","2022-03-24","2021-12-21","2020-05-13","2022-03-30","2021-12-06","2022-01-21","2020-07-02","2021-12-29","2020-07-01","2020-07-01","2020-07-01","2020-07-01","2020-07-01","2020-08-07","2020-07-15","2020-07-31","2020-07-31","2020-09-12","2020-08-07","2020-09-03","2020-10-07","2020-09-12","2020-09-12","2022-03-24","2020-10-07","2020-10-07","2020-12-04","2021-12-26","2021-01-13","2022-01-21","2021-01-13","2022-03-19","2021-03-24","2020-12-01","2021-03-24","2020-12-04","2020-12-04","2020-12-04","2020-12-08","2021-06-11","2021-06-11","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2021-01-13","2022-01-21","2021-01-20","2021-01-20","2022-02-19","2021-04-14","2022-01-21","2022-01-21","2022-01-21","2021-10-26","2021-10-26","2021-11-12","2021-11-12","2021-11-30","2021-11-12","2022-03-27","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2022-03-04","2022-03-04","2022-03-30","2022-03-27","2022-03-19","2021-11-30","2021-11-30","2021-11-30","2021-11-30","2021-11-30","2021-12-01","2021-12-01","2022-03-27","2021-12-01","2022-03-27","2022-03-26","2021-12-22","2021-12-06","2021-12-06","2021-12-06","2021-12-21","2022-03-19","2021-12-06","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2021-12-26","2021-12-26","2021-12-29","2021-12-29","2022-03-19","2021-12-29","2022-03-04","2021-12-29","2021-12-29","2022-02-19","2022-02-19","2022-03-04","2022-03-04","2022-03-04","2022-03-04","2022-03-30","2022-03-27","2022-03-19","2022-03-19","2022-03-19","2022-03-19","2022-03-19","2022-03-19","2022-03-19","2022-03-27","2022-03-27","2022-03-27","2022-03-26","2022-03-26","2022-03-27"],"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":[["","59267100002","PFIZER","INJ COVID-19","0.30","Select","Select",""],["","00093317431","ALBUTEROL","FAT E","8.50","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","90.00","Select","Select",""],["","62332049241","TIZANIDINE","CAP 4MG","30.00","Select","Select",""],["","59148003713","REXULTI","TAB 1MG","30.00","Select","Select",""],["","00093816601","QUETIAPINE","TAB 50MG","30.00","Select","Select",""],["","49281042150","FLUZONE","INJ 2021-22","0.50","Select","Select",""],["","43547040211","FUROSEMIDE","TAB 40MG","30.00","Select","Select",""],["","00527150537","AMPHET\/DEXTR","TAB 20MG","60.00","Select","Select",""],["","16729018201","HYDROCHLOROT","TAB 12.5MG","90.00","Select","Select",""],["","00000000000",""," ","120.00","Select","Select",""],["","43547030403","ARIPIPRAZOLE","TAB 10MG","30.00","Select","Select",""],["","65862035790","CLOPIDOGREL","TAB 75MG","30.00","Select","Select",""],["","51991074690","DULOXETINE","CAP 20MG","60.00","Select","Select",""],["","65862022960","LAMOTRIGINE","TAB 150MG","30.00","Select","Select",""],["","69238183801","LEVOTHYROXIN","TAB 150MCG","30.00","Select","Select",""],["","70377002911","ATORVASTATIN","TAB 40MG","30.00","Select","Select",""],["","68682099398","DILTIAZEM","CAP 120MG ER","90.00","Select","Select",""],["","00002751001","HUMALOG","INJ 100\/ML","30.00","Select","Select",""],["","00193731221","CONTOUR","TES NEXT","200.00","Select","Select",""],["","50742061610","METOPROL","TAB 50MG ER","30.00","Select","Select",""],["","67877056105","METFORMIN","TAB 500MG","180.00","Select","Select",""],["","67877025145","TRIAMCINOLON","CRE 0.001","454.00","Select","Select",""],["","00002771559","BASAGLAR","INJ 100UNIT","30.00","Select","Select",""],["","00536123201","ASPIRIN","TAB 325MG EC","30.00","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","100.00","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4.00","Select","Select",""],["","68180097903","LISINOPRIL","TAB 40MG","30.00","Select","Select",""],["","08290320119","BD  PEN NEEDL","MIS 31GX5MM","100.00","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","10.00","Select","Select",""],["","16571040250","CETIRIZINE","TAB 10MG","30.00","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","14.00","Select","Select",""],["","68382025601","OXYBUTYNIN","TAB 10MG ER","30.00","Select","Select",""],["","00228212750","CLONIDINE","TAB 0.1MG","60.00","Select","Select",""],["","62037059790","CARTIA","CAP 120\/24HR","16.00","Select","Select",""],["","66993096045","METRONIDAZOL","CRE 0.0075","45.00","Select","Select",""],["","69097015907","MELOXICAM","TAB 15MG","30.00","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6.00","Select","Select",""],["","00603188016","LIDOCAINE","PAD 0.05","30.00","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","30.00","Select","Select",""],["","67877057505","BENZONATATE","CAP 200MG","30.00","Select","Select",""],["","71093014005","METHOCARBAM","TAB 500MG","40.00","Select","Select",""],["","69238115409","EZETIMIBE","TAB 10MG","30.00","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","30.00","Select","Select",""],["","08290328418","INSULIN","MIS 1ML\/31G","100.00","Select","Select",""],["","59676058015","JANSSEN","INJ COVID-19","0.50","Select","Select",""],["","65862053650","LEVOFLOXACIN","TAB 250MG","7.00","Select","Select",""],["","51293081001","PHENAZOPYRID","TAB 100MG","9.00","Select","Select",""],["","69097081312","GABAPENTIN","CAP 100MG","60.00","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","20.00","Select","Select",""],["","00093005805","TRAMADOL","TAB 50MG","15.00","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","10.00","Select","Select",""],["","68382031818","MINOCYCLINE","CAP 100MG","30.00","Select","Select",""],["","70710114003","FLUCONAZOLE","TAB 200MG","14.00","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","21.00","Select","Select",""],["","66689000816","NYSTATIN","SUS 100000","100.00","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":{"indx":[["","",""],[""],[""],[""],[""]],"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":""}]}]}