{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TUCKER  C CLARKE","gend":0,"add":"11912 BARREL COOPER CT","city":"RESTON","state":"VA","zip":"20191-9998","dob":"1984-07-27","age":"","mstatus":"","insh":"20060359*01","cliId":"","pno":5714903353,"cno":5714903353,"email":"","ename":"","eno":"","pphy":"MOFID-WOO, FOROUZANDEH MD","ppno":7032373446,"pcpadd":"8221 WILLOW OAKS CORPRATE DRIVE SUI","pcpcity":"FAIRFAX","pcpstate":"VA","pcpzip":"22031-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7037511003,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.2","T14.91XS","F43.21","F25.1","F14.21","F11.21","F12.20","I10.","F32.3","Z59.0","Z91.5","F33.9","F10.10","F42.2","F45.22","F31.4","F43.12","F40.01","F41.1","F60.3","F23.","K04.7","L03.211","Z20.822","K02.9","F20.9","R07.9","F25.9","F14.20","F11.20","F13.10","F33.42","F43.10","F33.1","F41.9","F14.10","F41.0","F32.81","Z62.820","F32.1","Z62.810","Z62.29","Z63.8","F15.20","F29.","L02.01","E87.6","F12.10","NO DATA","Z56.0","Z55.8","Z65.3","F20.0","F14.23","F31.32","F90.2","F10.20","Z76.89","Z13.1","Z13.220","Z13.29"],"date":["2021-07-08","2021-07-08","2021-07-08","2023-04-13","2023-04-13","2023-04-13","2023-04-13","2023-04-13","2021-03-04","2021-03-04","2021-05-28","2021-06-17","2021-03-04","2021-06-17","2021-06-17","2021-03-04","2021-12-09","2021-08-19","2021-03-04","2021-03-04","2021-05-27","2021-05-27","2021-05-28","2021-05-27","2021-05-28","2021-06-08","2021-05-27","2021-06-05","2021-12-09","2022-01-06","2021-08-19","2021-08-19","2021-08-19","2022-01-06","2022-01-06","2022-01-06","2021-12-09","2021-12-09","2021-12-09","2021-12-09","2021-12-09","2021-12-09","2021-12-09","2021-12-09","2021-05-27","2021-05-28","2021-05-27","2021-05-28","2021-06-17","2021-05-28","2021-05-28","2021-06-17","2021-06-09","2021-10-13","2021-10-13","2021-10-13","2021-06-17","2021-06-30","2021-06-30","2021-06-30","2021-06-30"],"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":[["","67457035959","FLUPHENAZ DE","INJ 25MG\/ML","5","Select","Select",""],["","00536354710","DAILY-VITE","400 MCG","30","Select","Select",""],["","45963070911","METOPROL SUC","TAB 25MG ER","90","Select","Select",""],["","60505257908","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","68180031902","BUPROPN HCL","TAB 150MG XL","30","Select","Select",""],["","00904530780","BANOPHEN","CAP 50MG","30","Select","Select",""],["","43292056371","VITAMIN D3","TAB 2000UNIT","30","Select","Select",""],["","65862019399","FLUOXETINE","CAP 20MG","90","Select","Select",""],["","59267100002","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","69315013710","BENZTROPINE","TAB 1MG","30","Select","Select",""],["","69238168101","FLUPHENAZINE","TAB 10MG","14","Select","Select",""],["","00093227534","AMOX\/K CLAV","TAB 875-125","14","Select","Select",""],["","31604002673","D3","TAB 2000UNIT","90","Select","Select",""],["","43292056371","VITAMIN D","3 50 MCG","30","Select","Select",""],["","70370204806","INGREZZA","CAP 40-80MG","28","Select","Select",""],["","70461032203","FLUCLVX QUAD","INJ 2022-23","0","Select","Select",""],["","00904205661","DIPHENHYDRAM","CAP 50MG","30","Select","Select",""],["","59267030402","PFIZER BIVAL","INJ BA4\/BA5","0","Select","Select",""],["","00143952901","FLUPHENAZINE DECANOATE","25 MG\/ML","5","Select","Select",""],["","60505257908","ATORVASTATIN CALCIUM","20 MG","30","Select","Select",""],["","65862019399","FLUOXETINE HCL","20 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":""}]}]}