{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MUHAMMAD IQBAL","gend":0,"add":"1021 HARBOUR DR APT 109","city":"STAFFORD","state":"VA","zip":22554,"dob":"1948-12-01","age":"","mstatus":"","insh":"20046815*01","cliId":"","pno":"703\/937-7195","cno":"","email":"","ename":"","eno":"","pphy":"Abdel Shaheed, Samir","ppno":"571\/542-4950","pcpadd":"3925 Portsmouth Boulevard","pcpcity":"Chesapeake","pcpstate":"VA","pcpzip":22554,"pcpcounty":"","pcpid":"","pcpname":"SENTARA MEDICAL GROUP","plan":"OHP","program":"Medicaid","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"000\/000-0000","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G20.","E11.9","K21.9","E78.2","E11.65","I10.","J45.998","I20.9","Z79.4","Z79.82","Z95.1","Z91.81","J45.901","L03.031","B35.6","R00.0","E03.9","I25.10","R29.810","R47.1","R06.01","R22.43","R21.","Z00.01","Z28.21","Z12.5","Z12.11","E78.9","K59.00","R39.11","Z20.822","Z53.29","Z79.84","Z79.890","I63.9","R26.81"],"date":["2022-10-25","2022-09-12","2022-09-12","2019-07-08","2019-09-05","2022-09-12","2019-08-14","2019-08-06","2022-09-01","2022-09-01","2022-09-01","2019-08-06","2019-08-21","2019-09-16","2019-09-16","2019-09-11","2019-09-11","2022-09-01","2022-09-01","2022-09-01","2022-09-12","2022-09-12","2022-09-12","2022-08-15","2022-08-15","2022-08-15","2022-08-15","2022-08-15","2022-08-15","2022-08-15","2022-09-01","2022-09-01","2022-09-01","2022-09-01","2022-09-01","2022-10-25"],"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":[["","00088221905","LANTUS","INJ 100\/ML","15","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","15","Select","Select",""],["","68462039130","ESOMEPRA","CAP 40MG DR","30","Select","Select",""],["","70377002811","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","57237001401","TAMSULOSIN","CAP 0.4MG","90","Select","Select",""],["","45802086866","POLYETH","POW 3350 NF","30","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA BL","100","Select","Select",""],["","49483048112","ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","08290320122","BD  PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","45802048678","DOCUSATE","CAP 100MG","30","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","90","Select","Select",""],["","00378172193","AMLOD\/VALSAR","TAB 5-160MG","90","Select","Select",""],["","45802043803","HYDROCORT","CRE 0.01","28","Select","Select",""],["","00378668910","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","69452014220","AMANTADINE","CAP 100MG","90","Select","Select",""],["","43547027010","ROPINIROLE","TAB 1MG","150","Select","Select",""],["","51862085501","CARB\/LEVO","TAB 10-100MG","240","Select","Select",""],["","16571069101","CARB\/LEVO100","TAB \/ENTACAP","270","Select","Select",""],["","43547040111","FUROSEMIDE","TAB 20MG","5","Select","Select",""],["","50742061510","METOPROL","TAB 25MG ER","30","Select","Select",""],["","62332004690","VALSARTAN","TAB 160MG","30","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","00378180310","LEVOTHYROXIN","TAB 50MCG","30","Select","Select",""],["","","BUDES\/FORMOT","AER 80-4.5","","Select","Select",""],["","00186037220","SYMBICORT","AER 80-4.5","10","Select","Select",""],["","00002871501","HUMULIN","INJ 70\/30","10","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","17","Select","Select",""],["","66685100100","AMOX\/K","TAB 875-125","20","Select","Select",""],["","00713067115","KETOCONAZOLE","CRE 0.02","45","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","00169183711","NOVOLIN","INJ 70\/30","10","Select","Select",""],["","59310057922","PROAIR","AER ","17","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":[]}},{"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":""}]}]}