{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MIR SIDDIQ","gend":0,"add":"6 VESTA DR","city":"FREDERICKSBURG","state":"VA","zip":"22405-9998","dob":"1966-01-06","age":"","mstatus":"","insh":"2236457*01","cliId":"","pno":"540\/809-6045","cno":"540\/809-6045","email":"","ename":"","eno":"","pphy":"ESANCY, MARY NP","ppno":"540\/361-2040","pcpadd":"STE 201 1451 HOSPITAL DR","pcpcity":"FREDERICKSBURG","pcpstate":"VA","pcpzip":22401,"pcpcounty":"","pcpid":"","pcpname":"Pratt Medical Group- T. Stacey Lloyd Campus","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/361-2058","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R06.00","U07.1","J12.89","J96.01","J30.89","J32.9","H10.13","K51.90","R51.9","J18.9","R68.89","Z51.5","R53.81","J22.","B97.89","Z86.19","B34.9","Z79.899","J02.9","E78.5","D17.0","Z12.5","A41.89","E87.1","R65.20","E78.00","Z20.822","J30.9","R74.8","B97.29","R03.0","J06.9"],"date":["2020-04-04","2020-04-13","2020-04-13","2020-04-13","2022-04-14","2022-04-14","2022-04-14","2022-04-14","2022-04-14","2020-04-04","2020-04-04","2020-04-07","2020-04-07","2020-05-19","2020-05-19","2020-05-19","2022-05-03","2022-05-03","2022-05-03","2022-01-31","2022-01-31","2022-01-31","2020-04-04","2020-04-11","2020-04-04","2020-04-04","2021-06-30","2021-05-25","2020-04-11","2020-04-04","2021-05-25","2020-03-27"],"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":[["","54092019112","PENTASA","CAP 500MG CR","120","Select","Select",""],["","60505095303","AZEL\/FLUTIC","SPR 137-50","23","Select","Select",""],["","00093505998","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","42571012290","LEVOCETIRIZI","TAB 5MG","90","Select","Select",""],["","60505084805","AZELASTINE","SPR 0.0015","90","Select","Select",""],["","49035044301","NASAL","SPR 55MCG\/AC","51","Select","Select",""],["","71776002430","ZERVIATE","DRO 0.0024","30","Select","Select",""],["","45802010901","TRIAMCINOLON","AER 55MCG\/AC","51","Select","Select",""],["","00591224522","MESALAMINE","TAB 1.2GM","60","Select","Select",""],["","59267030401","PFIZER","INJ BA4\/BA5","0","Select","Select",""],["","41167351002","XYZAL","TAB 5MG","35","Select","Select",""],["","16571040250","CETIRIZINE","TAB 10MG","90","Select","Select",""],["","00067611730","ALLERGY","TAB 10MG","30","Select","Select",""],["","00037024523","DYMISTA","SPR 137-50","23","Select","Select",""],["","00781751787","BUDESONIDE","SUS 1MG\/2ML","60","Select","Select",""],["","00065081604","PATADAY","SOL 0.007","2","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","00406048410","APAP\/CODEINE","TAB 300-30MG","20","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","21","Select","Select",""],["","29300022019","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","54092047612","LIALDA","TAB 1.2GM","60","Select","Select",""],["","64380078706","BUSPIRONE","TAB 7.5MG","60","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","00487950125","ALBUTEROL","NEB 0.00083","150","Select","Select",""],["","69543025216","VIRTUSSIN","SOL 100-10\/5","200","Select","Select",""],["","50111078710","AZITHROMYCIN","TAB 250MG","4","Select","Select",""],["","43547040111","FUROSEMIDE","TAB 20MG","60","Select","Select",""],["","16714089802","LORATADINE","TAB 10MG","30","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":""}]}]}