{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GREGORY   T GUIFFRE","gend":0,"add":"117 HAITI ST","city":"WARRENTON","state":"VA","zip":"20186-9998","dob":"1970-01-30","age":"","mstatus":"","insh":"20068011*01","cliId":"","pno":"540\/878-9017","cno":"540\/878-9017","email":"","ename":"","eno":"","pphy":"KILYK, TONI C MD","ppno":"540\/347-0394","pcpadd":"35 ROCK POINTE LN","pcpcity":"WARRENTON","pcpstate":"VA","pcpzip":20186,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"NORTHERN\/ WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/349-3262","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.65","F17.200","F33.1","Z13.31","E11.9","R05.","M25.562","NO DATA","I25.10","F31.32","F12.20","F31.4","F41.1","F31.62","H26.101","H04.123","H52.7","Z76.89","Z72.0","I21.4","J44.9","I50.9","I10.","F33.2","R58.","D64.9","N18.30","E78.5","E53.8","R21.","J44.1","Z20.828","F17.210","R68.89","R06.00","R06.09","T50.8X5S","M10.172","G47.33","Z12.11","Z12.5","Z01.818","Z98.890","I25.119","J20.9","R19.5","R41.82","E78.2","I42.9","Z91.14"],"date":["2021-09-28","2021-08-16","2022-02-28","2021-09-28","2022-09-14","2020-12-14","2020-12-14","2022-06-27","2022-06-21","2022-06-27","2021-11-28","2021-11-22","2022-02-28","2022-01-07","2021-12-01","2021-12-01","2021-12-01","2022-08-16","2022-09-14","2022-03-11","2021-04-20","2021-06-15","2022-10-21","2021-08-12","2021-06-15","2021-06-15","2021-06-15","2022-06-27","2021-11-29","2020-08-07","2020-08-17","2020-08-17","2020-08-17","2020-08-17","2020-08-17","2020-08-17","2021-02-09","2021-07-06","2022-04-18","2022-04-18","2022-04-18","2021-01-04","2021-01-06","2021-01-06","2020-08-24","2020-08-24","2022-01-28","2021-03-15","2021-03-15","2021-03-18"],"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":[["","62756079813","DIVALPROEX","TAB 500MG DR","18","Select","Select",""],["","69315012701","FOLIC","TAB 1000MCG","28","Select","Select",""],["","68645055154","LISINOPRIL","TAB 5MG","30","Select","Select",""],["","68462026430","ROSUVASTATIN","TAB 40MG","28","Select","Select",""],["","00597015290","JARDIANCE","TAB 10MG","28","Select","Select",""],["","67877024910","QUETIAPINE","TAB 50MG","42","Select","Select",""],["","68645059090","CLOPIDOGREL","TAB 75MG","90","Select","Select",""],["","68382009405","CARVEDILOL","TAB 12.5MG","180","Select","Select",""],["","00280210032","ASPIRIN","TAB 81MG EC","24","Select","Select",""],["","68180032006","BUPROPN","TAB 300MG XL","28","Select","Select",""],["","67877022301","GABAPENTIN","CAP 300MG","84","Select","Select",""],["","68645058259","METFORMIN","TAB 500MG","120","Select","Select",""],["","59762330403","NITROGLYCERN","SUB 0.4MG","25","Select","Select",""],["","59746021601","SPIRONOLACT","TAB 25MG","30","Select","Select",""],["","65162090103","ARIPIPRAZOLE","TAB 20MG","28","Select","Select",""],["","53451010101","HORIZANT","TAB 600MG ER","28","Select","Select",""],["","65162019011","NAPROXEN","TAB 500MG","30","Select","Select",""],["","29300041519","CYCLOBENZAPR","TAB 10MG","20","Select","Select",""],["","00536589588","NICOTINE","DIS 14MG\/24H","28","Select","Select",""],["","63402030230","LATUDA","TAB 20MG","30","Select","Select",""],["","00093520006","BUSPIRONE","TAB 30MG","180","Select","Select",""],["","43547028211","ESCITALOPRAM","TAB 20MG","45","Select","Select",""],["","00093505898","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","43547040211","FUROSEMIDE","TAB 40MG","180","Select","Select",""],["","00172402980","INDOMETHACIN","CAP 25MG","20","Select","Select",""],["","00591256201","COLCHICINE","TAB 0.6MG","6","Select","Select",""],["","70436005801","BUPROPION","TAB 100MG SR","12","Select","Select",""],["","00487950125","ALBUTEROL","NEB 0.00083","75","Select","Select",""],["","65162027250","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","10","Select","Select",""],["","68645014059","FAMOTIDINE","TAB 20MG","3","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":""}]}]}