{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NELIDA C BALLENA DE RAMIREZ","gend":1,"add":"15 ATHENA DR","city":"STAFFORD","state":"VA","zip":"22554-9998","dob":"1932-07-20","age":"","mstatus":"","insh":"20023520*01","cliId":"","pno":5712432144,"cno":5712432144,"email":"","ename":"","eno":"","pphy":"HOLTAN, DANIEL MD","ppno":7035355568,"pcpadd":"2120 WASHINGTON BLVD","pcpcity":"ARLINGTON","pcpstate":"VA","pcpzip":"22204-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7032991794,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","M19.041","M19.042","M85.80","I48.0","R57.0","A41.9","I11.0","I50.21","J18.9","J96.01","J81.0","J98.11","N12.","R65.21","K72.00","G93.41","R53.81","Z51.5","NO DATA","G89.29","E78.00","Z23.","N17.9","E87.5","E87.1","N39.0","I50.42","H53.8","R73.03","E78.5","K21.9","H91.90","Z66.","I42.9","E04.1","I48.91","R06.03","I50.9","R79.89","R57.9"],"date":["2022-10-05","2021-11-22","2021-11-22","2022-10-05","2022-12-05","2022-12-05","2022-12-05","2022-12-05","2022-12-05","2022-12-05","2022-12-05","2022-12-07","2022-12-05","2022-12-05","2022-12-05","2022-12-05","2022-12-05","2022-12-10","2022-12-06","2022-12-06","2022-12-06","2022-05-02","2021-09-28","2022-12-07","2022-12-07","2022-12-07","2022-12-07","2022-12-11","2021-01-07","2022-10-05","2022-12-04","2022-12-04","2022-12-04","2022-12-04","2022-12-04","2021-03-09","2022-12-05","2022-12-05","2022-12-04","2022-12-04","2022-12-05"],"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":[["","67877019705","AMLODIPINE","TAB 2.5MG","90","Select","Select",""],["","65162063609","PANTOPRAZOLE","TAB 20MG","90","Select","Select",""],["","00093505698","ATORVASTATIN","TAB 10MG","90","Select","Select",""],["","31722070290","LOSARTAN POT","TAB 100MG","90","Select","Select",""],["","80777027399","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","37205043198","CALCIUM","TAB 500\/D","360","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","11877001140","BINAXNOW COV","KIT HOME TES","8","Select","Select",""],["","49281012265","FLUZONE HD","INJ 2022-23","1","Select","Select",""],["","00406800330","MORPHINE SUL","SOL 100\/5ML","30","Select","Select",""],["","68047025301","OSCIMIN","SUB 0.125MG","45","Select","Select",""],["","42192033901","HYOSCYAMINE","SUB 0.125MG","45","Select","Select",""],["","45802073030","ACETAMIN","SUP 650MG","12","Select","Select",""],["","00904714212","BISACODYL","SUP 10MG","12","Select","Select",""],["","00093342510","LORAZEPAM","TAB 0.5MG","20","Select","Select",""],["","00121058104","HALOPERIDOL","CON 2MG\/ML","15","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":""}]}]}