{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HUSNA SAYED","gend":1,"add":"5607 ACREE AVE APT 304","city":"FREDERICKSBURG","state":"VA","zip":"22407-9998","dob":"1982-03-08","age":"","mstatus":"","insh":"2236357*01","cliId":"","pno":"540\/684-0576","cno":"","email":"","ename":"","eno":"","pphy":"CASTELLUCCI, JAMI L NP","ppno":"540\/423-6600","pcpadd":"4604 SPOTSLYVANIA PKWY SUITE 200","pcpcity":"FREDERICKSBURG","pcpstate":"VA","pcpzip":22408,"pcpcounty":"","pcpid":"","pcpname":"SPOTSYLVANIA MULTI SPECIALTY GROUP LLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/423-6655","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.419","Z32.02","R20.2","K21.9","O20.9","H61.21","O09.523","O24.414","O34.219","O24.420","Z20.828","O34.211","Z37.0","Z3A.39","Z37.9","Z3A.00","Z09.","L76.82","Z00.00","Z13.220","Z13.29","L81.9","Z86.32","Z76.89","L70.0","Z30.9","NO DATA","O36.8130","Z3A.29","Z39.1","R53.1","Z32.01","O21.0","O23.41","O36.8120","O82."],"date":["2019-11-14","2020-02-27","2019-12-25","2021-07-09","2020-05-08","2021-07-28","2020-12-11","2020-12-11","2020-12-14","2020-12-14","2020-12-14","2020-12-14","2020-12-14","2020-12-14","2020-12-14","2020-12-14","2020-12-23","2020-12-23","2021-07-09","2021-07-09","2021-07-09","2021-07-09","2021-07-09","2021-07-09","2021-10-25","2021-12-27","2021-12-27","2020-10-06","2020-10-06","2020-12-05","2020-02-27","2020-04-30","2020-04-30","2020-04-30","2020-10-06","2020-12-14"],"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":[["","","PRENATAL"," PRENATAL ","30","Select","Select",""],["","","PRENATABS"," PRENATABS ","90","Select","Select",""],["","","OMEPRAZOLE"," OMEPRAZOLE ","30","Select","Select",""],["","","CL","TAB 28-0.8MG","","Select","Select",""],["","","FREESTYLE    MIS LITE","MIS LITE","","Select","Select",""],["","","ONETOUCH","TES VERIO","","Select","Select",""],["","","FREESTYLE    MIS LANCETS","MIS LANCETS","","Select","Select",""],["","","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","","NITROFURANTN","CAP 100MG","","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","","FREESTYLE    TES LITE","TES LITE","","Select","Select",""],["","","FREESTYLE    TES INSULINX","TES INSULINX","","Select","Select",""],["","","OXYCOD\/APAP","TAB 5-325MG","","Select","Select",""],["","","PANTOPRAZOLE","TAB 20MG","","Select","Select",""],["","","DOCUSATE","CAP 100MG","","Select","Select",""],["","","IBUPROFEN","TAB 800MG","","Select","Select",""],["","","PROMETHAZINE","TAB 12.5MG","","Select","Select",""],["","","STOOL","CAP 100MG","","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":""}]}]}