{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MOSTAFA DEBAB SR","gend":0,"add":"309 STAUNTON CTS","city":"STAFFORD","state":"VA","zip":"22554-9998","dob":"1956-05-05","age":"","mstatus":"","insh":"20057287*01","cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"KAHN, ENAMUL MD","ppno":"540\/659-0550","pcpadd":"SUITE 101 237 GARRISONVILLE RD","pcpcity":"STAFFORD","pcpstate":"VA","pcpzip":22554,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/720-2386","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R55.","E78.00","I50.22","I10.","I06.9","I62.01","E43.","G93.6","G93.5","E87.2","G93.40","I50.42","Z68.1","E78.5","R40.2342","V72.85","H91.91","I08.0","I11.0","M26.31","M40.209","R41.82","S06.5X0A","S06.5X9A","J96.00","Z95.2","R56.9","Z23.","H92.01","R00.2","Z00.00","I35.9","J96.01","R65.10","R40.20","I62.03","I62.00","G93.41","Q87.40","D72.829","Z95.3","Z83.3","Z20.822","H00.021","H00.022","H00.024","H00.025"],"date":["2021-03-25","2022-04-26","2022-04-26","2022-04-26","2022-04-26","2020-08-12","2020-03-20","2020-03-20","2020-03-20","2021-02-26","2021-02-28","2021-02-26","2020-03-20","2021-02-26","2020-03-20","2020-03-20","2021-02-26","2021-02-26","2021-02-26","2020-03-20","2020-03-20","2021-02-28","2020-03-20","2022-02-22","2021-02-28","2021-03-08","2022-02-22","2021-11-30","2020-11-10","2020-03-17","2021-03-02","2020-12-02","2021-02-26","2021-02-26","2021-02-26","2020-06-01","2020-03-21","2021-02-26","2021-02-26","2021-02-26","2021-02-26","2021-02-26","2021-02-26","2020-08-18","2020-08-18","2020-08-18","2020-08-18"],"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":[]},{"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":[["","16714035502","LEVETIRACETA","TAB 500MG","14","Select","Select",""],["","31722070090","LOSARTAN","TAB 25MG","30","Select","Select",""],["","57237010099","METOPROL","TAB 25MG","60","Select","Select",""],["","00093505998","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","12","Select","Select",""],["","00406048410","APAP\/CODEINE","TAB 300-30MG","45","Select","Select",""],["","24208041010","OFLOXACIN","DRO 0.3%OTIC","10","Select","Select",""],["","59762004901","METHYLPRED","TAB 8MG","126","Select","Select",""],["","68645051554","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","69918030130","TRANEX","TAB 650MG","30","Select","Select",""],["","61314063006","NEO\/POLY\/DEX","SUS 0.1% OP","5","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":""}]}]}