{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ATALAYA IQBAL-SINGH","gend":1,"add":"115 RIVA CT APT 203","city":"YORKTOWN","state":"VA","zip":"23690-9998","dob":"1989-05-09","age":"","mstatus":"","insh":"1590253*01","cliId":"","pno":7578499994,"cno":7578499994,"email":"","ename":"","eno":"","pphy":"HARTUNG, HILLARY M PA","ppno":7574468999,"pcpadd":"SUITE 572 825 FAIRFAX AVE,","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23507-9998","pcpcounty":"","pcpid":"","pcpname":"EVMS Infectious Diseases","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7574467922,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E66.01","Z68.44","G47.30","K21.9","B20.","M54.9","V23.89","O99.345","R56.9","NO DATA","Z71.3","K85.90","G40.909","K76.0","Z68.43","Z79.899","Z87.19","Z87.891","Z90.49","R10.9","R94.6","E83.52","Z21.","Z86.39","E05.90","E21.3","Z11.3","Z13.220","G47.33","C73.","Z30.46","Z32.02","K80.20","Z01.419","E21.0","E89.0","Z88.5","Z88.8","G89.18","L03.90","Z97.8","T81.89XA","K82.8","K85.00","E04.2","E05.00","R74.9","F41.8","J20.8","Z20.822","Z90.89","Z91.018","R52.","R20.2","R20.0","E89.2","Z85.850","N20.0","R10.12","R16.2","S93.401A","S93.601A","M25.571","R11.0","Z00.00","R07.9","D35.1","Z01.818","S00.83XA","N39.0","B96.89","L03.221","E55.9","K80.10","E04.1","R79.89","Z11.1","S09.93XA","R51.9","E05.20","Z86.16","S69.92XA","F17.210","Z04.3","E20.8"],"date":["2023-04-22","2021-05-19","2022-08-08","2022-08-04","2023-06-02","2021-05-19","2021-05-19","2021-05-19","2022-11-04","2022-08-08","2021-05-19","2021-11-07","2023-02-26","2021-11-07","2023-04-22","2023-04-22","2021-11-10","2023-06-02","2022-08-09","2021-11-07","2021-11-19","2022-02-15","2022-08-09","2021-11-19","2023-03-19","2023-03-19","2022-12-02","2022-12-02","2023-04-10","2022-10-12","2021-04-27","2021-04-27","2021-07-05","2021-08-17","2022-08-04","2023-04-25","2022-08-04","2022-08-04","2022-08-08","2022-08-08","2022-08-08","2022-08-08","2021-07-01","2021-11-09","2022-08-22","2022-02-15","2022-02-15","2022-02-15","2022-03-06","2022-03-11","2022-03-06","2022-03-06","2022-03-06","2022-08-09","2022-08-09","2023-02-21","2023-02-21","2021-07-19","2021-07-19","2021-07-19","2023-03-19","2023-03-19","2023-03-19","2021-11-10","2021-11-10","2021-11-14","2022-08-04","2022-08-03","2023-02-26","2021-09-02","2021-09-02","2022-08-08","2023-02-21","2021-07-05","2022-02-02","2022-02-02","2022-12-02","2023-02-26","2023-02-26","2022-02-02","2022-03-11","2023-04-22","2023-04-22","2023-04-22","2023-04-25"],"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":[["","68382003516","VENLAFAXINE","CAP 75MG ER","90","Select","Select",""],["","49702023113","TRIUMEQ","TAB ","30","Select","Select",""],["","13668004701","LAMOTRIGINE","100 MG","360","Select","Select",""],["","68382000514","TOPIRAMATE","25 MG","60","Select","Select",""],["","70700012185","TRI-ESTARYLL","TAB ","84","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","20","Select","Select",""],["","71930004512","OXYCOD\/APAP","TAB 5-325MG","15","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","6","Select","Select",""],["","51293061201","PHENAZOPYRID","TAB 200MG","10","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","14","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","10","Select","Select",""],["","49702024613","DOVATO","50MG-300MG","30","Select","Select",""],["","60846050201","PYRIDIUM","TAB 200MG","10","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","49884064001","METHIMAZOLE","TAB 5MG","15","Select","Select",""],["","00228234810","PROPYLTHIOUR","TAB 50MG","30","Select","Select",""],["","64380071207","BENZONATATE","CAP 100MG","30","Select","Select",""],["","80681017401","VITAMIN D3","CAP 1.25MG","12","Select","Select",""],["","53191036201","D3-50","CAP 50000UNT","4","Select","Select",""],["","00378181377","LEVOTHYROXIN","TAB 125MCG","90","Select","Select",""],["","69452020720","CALCITRIOL","0.25 MCG","30","Select","Select",""],["","00904699880","DOCUSATE SOD","CAP 100MG","20","Select","Select",""],["","49483034001","ACETAMIN","TAB 325MG","30","Select","Select",""],["","70000003401","ANTACID","CHW 500MG","180","Select","Select",""],["","57896076315","CALCIUM CARB","CHW 500MG","150","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","68382003516","VENLAFAXINE HCL ER","75 MG","90","Select","Select",""],["","53191036201","D3","50 1250 MCG","4","Select","Select",""],["","00378181710","LEVOTHYROXINE SODIUM","175 MCG","90","Select","Select",""],["","80681017401","VITAMIN D","3 1250 MCG","4","Select","Select",""],["","57896076315","CALCIUM CARBONATE","200(500)MG","150","Select","Select",""],["","53191036201","D","3-50 1250 MCG","4","Select","Select",""],["","65862039010","ONDANSETRON ODT","4 MG","20","Select","Select",""],["","65862050320","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","14","Select","Select",""],["","49884064001","METHIMAZOLE TAB","5MG","15","Select","Select",""],["","49702024613","DOVATO TAB","50-300MG","30","Select","Select",""],["","13668004701","LAMOTRIGINE TAB","100MG","360","Select","Select",""],["","68382003516","VENLAFAXINE CAP","75MG ER","90","Select","Select",""],["","00228234810","PROPYLTHIOUR TAB","50MG","90","Select","Select",""],["","64380071207","BENZONATATE CAP","100MG","30","Select","Select",""],["","00378181377","LEVOTHYROXIN TAB","125MCG","90","Select","Select",""],["","65862042005","SMZ\/TMP DS TAB","800-160","14","Select","Select",""],["","69452020720","CALCITRIOL CAP","0.25MCG","30","Select","Select",""],["","71930004512","OXYCOD\/APAP TAB","5-325MG","15","Select","Select",""],["","00904699880","DOCUSATE SOD CAP","100MG","20","Select","Select",""],["","49483034001","ACETAMIN TAB","325MG","30","Select","Select",""],["","54738003060","ANTACID CHW","500MG","180","Select","Select",""],["","57896076315","CALCIUM CARB CHW","500MG","150","Select","Select",""],["","65862039010","ONDANSETRON TAB","4MG ODT","20","Select","Select",""],["","59746000103","METHYLPRED TAB","4MG","21","Select","Select",""],["","68382000514","TOPIRAMATE CAP","25MG","60","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":""}]}]}