{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DILSHAD MUHAMMAD","gend":1,"add":"13234 ROLLING PLAINS CT","city":"HERNDON","state":"VA","zip":"20171-9998","dob":"1976-02-17","age":"","mstatus":"","insh":"1667482*01","cliId":"","pno":5715087178,"cno":5715087178,"email":"","ename":"","eno":"","pphy":"MERKEL, VICTORIA MD","ppno":7033912020,"pcpadd":"3650JOSEPHSIEWICKDRIVE SUITE 400,","pcpcity":"FAIRFAX","pcpstate":"VA","pcpzip":"22033-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7033911211,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","H53.8","M79.645","R11.2","R05.9","J10.1","R05.","K21.9","Z86.16","G43.909","Z90.49","R11.10","N93.9","R82.90","F32.9","Z22.7","R73.9","E78.2","R51.9","G47.30","E66.01","R09.89","R10.30","R76.12","R59.9","R10.13","K92.1","Z12.11","R06.83","R07.89","R41.3","R19.8","R59.0","B34.9","J02.0","H92.02","Z20.822","G44.229","K29.50","B96.81","NO DATA","R19.4","I51.89","R76.11","Z88.5","R50.9","H92.03","R73.03","R35.0","Z82.0","R82.79","N89.9","Z30.431","Z30.9","N83.209","Z63.72","T20.10XA","X10.2XXA","Y93.G3","G47.33","N06.9","R19.7","Z30.430","J40.","Z20.828","M25.559","I70.213","M79.2","M20.5X2","M25.561","M54.32","R05.1","F43.9","R07.9","Z12.31","E78.5","R45.7","R20.2","G45.9","G89.0"],"date":["2023-04-14","2022-10-20","2022-10-20","2022-11-14","2023-03-05","2022-11-14","2021-08-12","2023-04-14","2021-09-29","2023-04-14","2021-08-01","2021-08-01","2021-08-30","2021-08-12","2022-06-06","2022-05-19","2022-10-06","2023-04-14","2022-10-06","2023-06-02","2022-10-06","2023-05-03","2021-05-03","2022-06-06","2021-06-28","2021-09-29","2021-06-28","2021-06-28","2022-06-06","2023-08-10","2023-08-28","2021-09-29","2021-08-31","2023-02-07","2023-03-05","2023-03-05","2023-03-05","2021-01-07","2021-09-29","2021-09-29","2023-08-15","2021-09-29","2021-09-29","2021-09-29","2021-09-29","2023-08-10","2023-03-05","2023-08-15","2023-04-14","2023-08-28","2023-06-02","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2021-01-25","2021-01-25","2021-01-25","2023-08-28","2021-05-03","2021-05-03","2021-09-07","2021-10-14","2021-10-14","2022-02-28","2022-03-23","2022-03-23","2022-03-23","2022-03-23","2022-03-23","2023-05-03","2023-07-19","2023-07-19","2023-08-15","2023-08-10","2023-07-19","2023-08-28","2023-08-28","2023-08-28"],"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":[["","68645059354","LISINOPRIL TAB","40MG","90","Select","Select",""],["","43386016106","MISOPROSTOL TAB","200MCG","4","Select","Select",""],["","65162083366","DICLOFENAC GEL","1%","100","Select","Select",""],["","42806040021","METHYLPRED TAB","4MG","21","Select","Select",""],["","70010010810","GABAPENTIN CAP","100MG","30","Select","Select",""],["","31722070190","LOSARTAN POT TAB","50MG","60","Select","Select",""],["","68645052254","SERTRALINE TAB","50MG","30","Select","Select",""],["","13668001990","VENLAFAXINE CAP","75MG ER","30","Select","Select",""],["","11877001140","BINAXNOW COV KIT HOME TES","","8","Select","Select",""],["","42806071401","BENZONATATE CAP","100MG","15","Select","Select",""],["","29300012613","BISOPROL FUM TAB","5MG","30","Select","Select",""],["","68645059459","FAMOTIDINE TAB","20MG","60","Select","Select",""],["","31722063231","OSELTAMIVIR CAP","75MG","10","Select","Select",""],["","55111015330","ONDANSETRON TAB","4MG","20","Select","Select",""],["","68645059459","FAMOTIDINE","20 MG","180","Select","Select",""],["","29300041519","CYCLOBENZAPRINE HCL","10 MG","15","Select","Select",""],["","31722070190","LOSARTAN POTASSIUM","50 MG","60","Select","Select",""],["","68645052154","SERTRALINE HCL","25 MG","90","Select","Select",""],["","69452014430","BENZONATATE","200 MG","30","Select","Select",""],["","65162019011","NAPROXEN","500 MG","20","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","00781261305","AMOXICILLIN","500 MG","20","Select","Select",""],["","00093342601","LORAZEPAM","1 MG","10","Select","Select",""],["","43386016106","MISOPROSTOL","TAB 200MCG","4","Select","Select",""],["","68645059354","LISINOPRIL","TAB 40MG","30","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","70010010810","GABAPENTIN","CAP 100MG","30","Select","Select",""],["","31722070190","LOSARTAN POT","TAB 50MG","30","Select","Select",""],["","13668001990","VENLAFAXINE","CAP 75MG ER","30","Select","Select",""],["","68645052254","SERTRALINE","TAB 50MG","30","Select","Select",""],["","29300012613","BISOPROL FUM","TAB 5MG","30","Select","Select",""],["","31722063231","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","55111015330","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","11877001140","BINAXNOW COV","KIT HOME TES","8","Select","Select",""],["","72205000599","ROSUVASTATIN CALCIUM","40 MG","90","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":""}]}]}