{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"FAYCAL DAHMANI","gend":0,"add":"5597 SEMINARY RD APT 1007S","city":"FALLS CHURCH","state":"VA","zip":"22041-9998","dob":"1966-09-03","age":"","mstatus":"","insh":"2143430*01","cliId":"","pno":"571\/278-9394","cno":"","email":"","ename":"","eno":"","pphy":"LUGO ESCHENWALD, VIVIAN MD","ppno":"703\/370-2400","pcpadd":"SUITE 330 2000 N BEAUREGARD ST","pcpcity":"ALEXANDRIA","pcpstate":"VA","pcpzip":22311,"pcpcounty":"","pcpid":"","pcpname":"LOUDOUN MEDICAL GROUP PC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"703\/370-7214","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z20.822","Z11.52","R50.9","Z74.3","R07.9","V54.12","R07.89","E78.5","I10.","Z72.0","J06.9","J32.9","R03.0","F17.210","R09.81","H65.199","J01.90","H69.80","H90.2","F41.0","R20.0","F41.9","R29.90","Z00.01","E11.9","E78.2","Z68.32","R12.","F17.200","Z23.","E78.00","N40.0","R00.2","R20.2","S62.336A","K21.9","R05.9","R11.0","R10.84","R14.0","Z01.89","G25.81","R29.898","Z68.33","R10.11","Z12.11","M79.673","R61.","R10.9","G89.29","R19.4","Z53.29","D12.2","K62.5","E66.9","R30.0","N40.1","M25.512","Z20.828"],"date":["2021-12-02","2022-01-31","2019-07-16","2019-07-16","2022-02-21","2020-12-11","2021-02-20","2021-04-14","2022-02-21","2022-02-21","2021-12-02","2019-09-30","2019-09-30","2021-04-14","2019-10-09","2019-10-09","2019-10-09","2019-10-09","2019-10-09","2021-04-14","2019-06-18","2021-04-14","2019-06-18","2020-06-16","2022-02-21","2020-06-16","2020-06-16","2020-06-16","2021-02-20","2020-06-16","2022-02-21","2020-09-16","2020-09-16","2020-08-14","2020-11-13","2020-02-04","2021-12-02","2021-12-02","2020-06-02","2020-06-02","2020-06-02","2020-06-02","2020-06-02","2020-06-02","2020-08-21","2020-08-21","2020-08-21","2021-02-25","2021-02-25","2021-02-25","2021-04-14","2021-04-14","2021-05-19","2021-05-19","2021-02-20","2022-06-27","2022-06-27","2022-06-27","2022-01-31"],"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":[["","70377000812","ROSUVASTATIN","TAB 20MG","30","Select","Select",""],["","16571041250","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","","TAMSULOSIN","CAP 0.4MG","","Select","Select",""],["","65862014990","FINASTERIDE","TAB 5MG","30","Select","Select",""],["","49483060350","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","50428317694","GAS","CAP 125MG","28","Select","Select",""],["","52268001201","SUPREP","SOL PREP KIT","354","Select","Select",""],["","","ATORVASTATIN","TAB 40MG","","Select","Select",""],["","","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","","SUCRALFATE","TAB 1GM","","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","64380071207","BENZONATATE","CAP 100MG","30","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","8","Select","Select",""],["","59779035740","CVS","SUS ANTI-GAS","355","Select","Select",""],["","","FLUZONE","INJ 2019-20","","Select","Select",""],["","","METFORMIN","TAB 500MG","","Select","Select",""],["","","OMEPRAZOLE","TAB 20MG","","Select","Select",""],["","","DICYCLOMINE","CAP 10MG","","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":{"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":""}]}]}