{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CARLTON PITTS","gend":0,"add":"4139 FOUNTAINSIDE LN UNIT 104","city":"FAIRFAX","state":"VA","zip":"22030-9998","dob":"1958-03-21","age":"","mstatus":"","insh":"2272300*01","cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"KIM, MICHAEL D MD","ppno":"703\/591-4100","pcpadd":"STE 700 10801 MAIN ST","pcpcity":"FAIRFAX","pcpstate":"VA","pcpzip":22030,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"703\/591-5380","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E78.5","B20.","Z13.1","I10.","B00.9","Z71.89","L73.8","L53.8","R20.8","Z78.9","E55.9","D48.5","N12.","D35.02","R10.9","L98.8","R19.7","N28.9","Z20.822","E86.0","N17.9","Z23.","A41.9","Z66.","R74.01","B18.2","G62.9","Z79.899","Z87.891","T50.2X5A"],"date":["2022-09-30","2022-09-30","2020-07-14","2022-09-30","2020-12-23","2020-12-23","2022-07-28","2022-05-24","2022-05-24","2022-05-24","2020-12-23","2022-01-25","2021-07-29","2021-12-22","2021-12-22","2022-07-28","2022-09-30","2022-09-30","2022-09-30","2022-09-30","2022-09-30","2022-03-17","2022-09-30","2022-09-30","2022-09-30","2022-09-30","2022-09-30","2022-09-30","2022-09-30","2022-09-30"],"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":[["","60505257809","ATORVASTATIN","TAB 10MG","30","Select","Select",""],["","43547035210","LISINOPRIL","TAB 5MG","30","Select","Select",""],["","00054040713","RITONAVIR","TAB 100MG","60","Select","Select",""],["","60219172206","ETRAVIRINE","TAB 200MG","60","Select","Select",""],["","29300012810","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","59746032430","VALACYCLOVIR","TAB 500MG","60","Select","Select",""],["","59676056201","PREZISTA","TAB 600MG","60","Select","Select",""],["","71930004212","HYDROCO\/APAP","TAB 5-300MG","10","Select","Select",""],["","00187209845","ARAZLO","LOT 0.00045","45","Select","Select",""],["","00006022761","ISENTRESS","TAB 400MG","60","Select","Select",""],["","00074333330","NORVIR","TAB 100MG","60","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","59676057101","INTELENCE","TAB 200MG","60","Select","Select",""],["","65162027250","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","69315090505","LORAZEPAM","TAB 1MG","2","Select","Select",""],["","61958070101","TRUVADA","TAB 200-300","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":""}]}]}