{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KEVIN   T DO","gend":0,"add":"4668 CONWELL DR APT 176","city":"ANNANDALE","state":"VA","zip":"22003-9998","dob":"1992-09-19","age":"","mstatus":"","insh":"20068828*01","cliId":"","pno":"804\/869-8834","cno":"804\/869-8834","email":"","ename":"","eno":"","pphy":"WISMAN, ERIN MD","ppno":"703\/237-3446","pcpadd":"8221 WILLOW OAKS CORPORATE DR STE 4","pcpcity":"FAIRFAX","pcpstate":"VA","pcpzip":22031,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"703\/224-3629","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.81","F43.10","G31.84","F90.0","F41.9","F33.2","F10.20","F41.1","F10.10","Z51.89","R00.0","Z03.818","Z20.822","F10.239","F32.9","Z72.0","F11.20","F13.10","F33.42","F40.01","F14.20","F12.20","F31.4","R07.9","T50.904A","Z74.3","M25.551","R41.3","F17.210","Z79.899","Z81.1","Z81.8"],"date":["2020-09-03","2022-11-09","2020-09-03","2020-09-03","2020-09-03","2022-11-09","2022-11-09","2022-11-09","2021-03-18","2021-03-01","2021-03-01","2021-06-09","2021-06-09","2021-03-04","2021-03-04","2021-03-04","2021-07-02","2021-07-02","2021-07-02","2021-07-02","2021-07-02","2021-07-02","2021-07-02","2021-02-28","2021-02-28","2021-02-28","2021-03-01","2021-03-01","2021-03-01","2021-03-01","2021-03-01","2021-03-01"],"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":[["","50428048545","CVS","TAB 100MG","30","Select","Select",""],["","70436001002","BUPROPN","TAB 150MG XL","30","Select","Select",""],["","13668013701","ESCITALOPRAM","TAB 20MG","30","Select","Select",""],["","70436006001","BUPROPION","TAB 200MG SR","60","Select","Select",""],["","16729008110","NALTREXONE","TAB 50MG","30","Select","Select",""],["","65757030001","VIVITROL","INJ 380MG","1","Select","Select",""],["","47781060730","DISULFIRAM","TAB 250MG","30","Select","Select",""],["","69238207807","PROPRANOLOL","TAB 20MG","90","Select","Select",""],["","16729028912","BUSPIRONE","TAB 30MG","60","Select","Select",""],["","10006070011","VITAMIN","TAB 100MG","30","Select","Select",""],["","69315012710","FOLIC","TAB 1000MCG","30","Select","Select",""],["","00536589688","NICOTINE","DIS 21MG\/24H","28","Select","Select",""],["","50111056002","TRAZODONE","TAB 50MG","30","Select","Select",""],["","43547040610","CLONAZEPAM","TAB 0.5MG","18","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":""}]}]}