{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LEONA   S ARBOGAST","gend":1,"add":"12160 COFFMAN CIR APT 444","city":"BEALETON","state":"VA","zip":"22712-9998","dob":"1943-01-19","age":"","mstatus":"","insh":"900042276*01","cliId":"","pno":"540\/878-1003","cno":"","email":"","ename":"","eno":"","pphy":"FIDA, AHMED MD","ppno":"540\/439-8100","pcpadd":"6200 STATION DRIVE","pcpcity":"BEALETON","pcpstate":"VA","pcpzip":22712,"pcpcounty":"","pcpid":"","pcpname":"FAUQUIER PHYSICIAN PRACTICES LLC","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/439-8797","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H92.01","H60.509","H66.91","M25.561","S61.217A","S16.1XXA","H92.02","W26.0XXA","X58.XXXA","J44.1","I10.","K21.9","F41.9","F32.9","Z88.7","Z79.899","Z20.822","R05.","R19.7","E78.5","F03.90","M17.11","M25.461","H11.31","H61.22","R11.2","Z74.3","R42.","E86.0","R51.9","I95.9","R68.89","R10.9","R22.2","J20.9","Z11.52","K46.9","B35.1","M79.672","M79.671","Z23.","J44.9","R06.02","R05.9","R09.81","R10.30","J43.9","R74.01","R80.9","Z87.19","E66.3","Z68.28","Z68.25","K43.9","F41.1","R26.81","J90."],"date":["2021-04-07","2021-04-14","2021-04-14","2021-04-20","2021-05-12","2021-05-12","2021-05-12","2021-05-12","2021-05-12","2021-12-13","2021-12-13","2021-12-13","2021-06-02","2021-06-02","2021-06-02","2021-10-08","2021-06-02","2021-06-09","2021-11-12","2021-11-16","2021-10-08","2021-04-29","2021-04-20","2021-05-11","2021-05-11","2021-10-08","2021-10-08","2021-10-08","2021-10-08","2021-10-08","2021-10-08","2021-10-08","2021-11-12","2021-11-12","2021-12-13","2021-01-19","2021-11-12","2021-02-11","2021-02-11","2021-02-11","2021-10-13","2021-12-15","2021-12-13","2021-12-13","2021-12-13","2021-01-12","2021-01-12","2021-01-12","2021-01-12","2021-04-29","2021-04-29","2021-04-29","2021-06-09","2021-11-16","2021-11-16","2021-01-19","2021-06-02"],"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":[]}]},{"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":[["","59746033090","DONEPEZIL HCL                                                         ","10MG","-90","Select","Select",""],["","13668001001","CITALOPRAM HYDROBROMIDE                                               ","20MG","90","Select","Select",""],["","00093720198","PRAVASTATIN SODIUM                                                    ","20MG","90","Select","Select",""],["","68180072003","AMLODIPINE BESYLATE                                                   ","5MG","90","Select","Select",""],["","61314064511","NEOMYCIN\/POLYMYXIN\/HYDROCORTISONE                                     ","1% OTIC","10","Select","Select",""],["","52817033010","CYCLOBENZAPRINE HYDROCHLORIDE                                         ","5MG","20","Select","Select",""],["","00781808926","AZITHROMYCIN                                                          ","250MG","6","Select","Select",""],["","65862050320","AMOXICILLIN\/CLAVULANATE POTASSIUM                                     ","875-125","14","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA                                                 ","HFA","8","Select","Select",""],["","70954005920","PREDNISONE                                                            ","10MG","48","Select","Select",""],["","76204020025","ALBUTEROL SULFATE                                                     ","0.08%","150","Select","Select",""],["","60432060416","PROMETHAZINE\/DEXTROMETHORPHAN                                         ","DM","100","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":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"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":""}]}]}