{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARIO HERNANDEZ HERNANDEZ","gend":0,"add":"3705 FAIRFIELD LN","city":"WOODBRIDGE","state":"VA","zip":"22193-9998","dob":"1965-02-13","age":"","mstatus":"","insh":"2190991*01","cliId":"","pno":"571\/501-3071","cno":"571\/501-3071","email":"","ename":"","eno":"","pphy":"WILLIAMS, RAENELL C MD","ppno":"571\/542-4950","pcpadd":"STE 170 4500 POND WAY","pcpcity":"WOODBRIDGE","pcpstate":"VA","pcpzip":22192,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"NORTHERN\/ WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S09.90XA","Z74.3","E11.65","E05.90","I10.","E66.01","Z68.37","R40.4","R55.","E87.1","E11.9","Z09.","F10.230","E83.42","R74.8","M20.21","M25.70","M65.871","E78.2","Z23.","NO DATA","D69.6","E66.09","Z68.33","Z12.5","Z01.818","M65.9","R42.","R05.9","G47.00","Z86.010","E86.0","K70.10","E03.9","I51.7","I77.810","G40.909","E86.9","Z83.3","Z79.899","Z79.51","Z79.84","R41.82","Z12.11","Z68.34","E66.9"],"date":["2020-10-23","2020-10-23","2022-08-24","2022-08-24","2022-05-25","2022-08-24","2022-05-25","2021-07-06","2021-07-08","2021-07-08","2022-05-25","2021-07-16","2021-07-16","2021-07-16","2021-08-16","2021-01-22","2021-01-22","2021-01-22","2022-08-24","2020-06-26","2020-06-26","2020-06-26","2020-10-02","2020-06-26","2022-05-25","2021-01-08","2021-01-08","2021-07-05","2022-05-25","2022-05-25","2020-01-09","2021-07-05","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2020-01-29","2020-10-02","2021-04-09"],"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":[["","68645019059","METOPROL","TAB 50MG","60","Select","Select",""],["","68645057290","GLIMEPIRIDE","TAB 2MG","180","Select","Select",""],["","67877041301","METFORMIN","TAB 500MG ER","180","Select","Select",""],["","16729017217","AMITRIPTYLIN","TAB 25MG","30","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","100","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","29300022019","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","69315012710","FOLIC","TAB 1000MCG","30","Select","Select",""],["","00005200010","PREVNAR","INJ ","0","Select","Select",""],["","00597015330","JARDIANCE","TAB 25MG","30","Select","Select",""],["","53885004401","ONE","KIT VERIO FL","1","Select","Select",""],["","65862001405","AMOXICILLIN","TAB 500MG","21","Select","Select",""],["","65162046550","IBUPROFEN","TAB 600MG","16","Select","Select",""],["","49281042050","FLUZONE","INJ 2020-21","0","Select","Select",""],["","51293082001","METHIMAZOLE","TAB 5MG","45","Select","Select",""],["","00093505698","ATORVASTATIN","TAB 10MG","30","Select","Select",""],["","00002143380","TRULICITY","INJ 0.75\/0.5","2","Select","Select",""],["","55111015330","ONDANSETRON","TAB 4MG","21","Select","Select",""],["","49281040020","ADACEL","INJ ","0","Select","Select",""],["","58160084252","BOOSTRIX","INJ ","0","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","21","Select","Select",""],["","00904679489","ASPIRIN","CHW 81MG","60","Select","Select",""],["","42858000101","OXYCODONE","TAB 5MG","30","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","43386009019","GAVILYTE-G","SOL ","4000","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","2","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","TES LITE","100","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":""}]}]}