{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MOHAMMAD   A KARIMI","gend":0,"add":"8600 DIXON POWERS DR                                        ","city":"HENRICO                       ","state":"VA","zip":"23228-2735","dob":"1947-01-01","age":"","mstatus":"","insh":10049742,"cliId":"","pno":8045174483,"cno":8045492800,"email":"","ename":"","eno":"","pphy":"SHUKLA, ANJALI HEMANT                                       ","ppno":"","pcpadd":"9600 PATTERSON AVENUE","pcpcity":"HENRICO                       ","pcpstate":"VA","pcpzip":232296053,"pcpcounty":"","pcpid":"P9058396","pcpname":"BON SECOURS CURE AND CARE","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"8600 DIXON POWERS DR                                        ","madd2":"                                                            ","madd3":"","mcity":"HENRICO                       ","mstate":"VA","mzip":"23228-2735","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J41.0","I50.22","E11.9","E78.00","I25.10","K64.8","Z23","F17.210","L72.0","E66.3","Z68.26","Z13.6","K63.5","Z12.11","D37.4","K57.30","K64.9","K57.90","J44.9","N40.0","I50.9","K21.9","I42.9","Z79.899","Z79.82","I25.5","I10","R93.1","Z95.1","M25.511","R93.7","M67.911","M75.101","Z01.810","Z01.811","E78.41","L21.0","Z01.818","R94.31","M75.81","M75.111","K64.4","L91.8","I11.0","E78.5","G89.29","Z79.84","Z79.4","N40.1","R35.0","M25.512","R41.3","J45.909","F17.200","E66.9","Z71.89","Z68.27","L72.3","Z48.02","M75.41","Z68.25","D50.9","H26.491","H26.492","H35.363","J44.1","R06.00","I08.3","R94.39"],"date":["2021-08-02","2021-08-02","2021-08-02","2021-09-24","2021-09-24","2019-03-19","2019-10-07","2019-03-19","2019-11-12","2019-10-07","2021-08-31","2019-01-16","2019-02-20","2019-02-20","2019-02-20","2019-02-20","2019-03-19","2019-02-20","2021-08-31","2019-02-20","2019-03-19","2019-02-20","2019-03-19","2019-03-19","2019-02-20","2021-09-24","2021-09-24","2020-01-15","2021-09-24","2019-06-14","2019-03-08","2019-03-08","2019-03-08","2019-03-12","2019-03-12","2019-03-12","2019-03-12","2019-03-12","2019-03-12","2019-03-18","2020-04-20","2019-03-19","2019-03-19","2019-03-19","2021-06-07","2019-03-19","2019-03-19","2019-03-19","2021-06-07","2021-06-07","2019-06-14","2019-09-30","2019-09-30","2019-09-30","2019-09-30","2019-10-07","2020-01-23","2020-01-07","2020-01-23","2020-04-20","2020-09-02","2021-06-07","2021-07-30","2021-07-30","2021-07-30","2021-08-03","2021-08-03","2021-09-24","2021-09-24"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","67877021620","CEFUROXIME","500MG","10","Select","Select",""],["","00591544305","PREDNISONE","20MG","12","Select","Select",""],["","00904645760","DOK","100MG","60","Select","Select",""],["","31722072690","MONTELUKAST","10MG","90","Select","Select",""],["","31722052530","FINASTERIDE","5MG","90","Select","Select",""],["","00186037020","SYMBICORT","160-4.5","10.2","Select","Select",""],["","29300012410","MELOXICAM","7.5MG","30","Select","Select",""],["","68382013201","TAMSULOSIN","0.4MG","30","Select","Select",""],["","00536100901","FERROUS","325MG","90","Select","Select",""],["","00054429731","FUROSEMIDE","20MG","60","Select","Select",""],["","55111032101","GLIMEPIRIDE","2MG","30","Select","Select",""],["","50742061510","METOPROL","25MG ER","90","Select","Select",""],["","70377002811","ATORVASTATIN","20MG","90","Select","Select",""],["","00904759080","FEROSUL","325MG","90","Select","Select",""],["","00363410040","STOOL","100MG","90","Select","Select",""],["","59267100001","PFIZER","COVID-19","0.3","Select","Select",""],["","00597002402","COMBIVENT","20-100","4","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","20","Select","Select",""],["","00093005805","TRAMADOL","50MG","30","Select","Select",""],["","67877021620","CEFUROXIME ","TAB 500MG","10","Select","Select",""],["","00591544305","PREDNISONE ","TAB 20MG","12","Select","Select",""],["","00904645760","DOK ","CAP 100MG","60","Select","Select",""],["","31722072690","MONTELUKAST ","TAB 10MG","90","Select","Select",""],["","31722052530","FINASTERIDE ","TAB 5MG","90","Select","Select",""],["","00186037020","SYMBICORT ","AER 160-4.5","10.2","Select","Select",""],["","29300012410","MELOXICAM ","TAB 7.5MG","30","Select","Select",""],["","68382013201","TAMSULOSIN ","CAP 0.4MG","30","Select","Select",""],["","00536100901","FERROUS ","TAB 325MG","90","Select","Select",""],["","00054429731","FUROSEMIDE ","TAB 20MG","60","Select","Select",""],["","55111032101","GLIMEPIRIDE ","TAB 2MG","30","Select","Select",""],["","50742061510","METOPROL ","TAB 25MG ER","90","Select","Select",""],["","70377002811","ATORVASTATIN ","TAB 20MG","90","Select","Select",""],["","00904759080","FEROSUL ","TAB 325MG","90","Select","Select",""],["","00363410040","STOOL ","CAP 100MG","90","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","00597002402","COMBIVENT ","AER 20-100","4","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","20","Select","Select",""],["","00093005805","TRAMADOL ","TAB 50MG","30","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}