{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOSEPH BANGURA-LEE","gend":0,"add":"C\/O HELEN MCCONNELL 12861 ISLAND HOUSE LOOP APT 303","city":"WOODBRIDGE","state":"VA","zip":"22193-9998","dob":"1989-05-26","age":"","mstatus":"","insh":"20062908*01","cliId":"","pno":7036787445,"cno":7036787445,"email":"","ename":"","eno":"","pphy":"SHAH, TEJAS J MD","ppno":7035800124,"pcpadd":"4331 RIDGEWOOD CENTER DR","pcpcity":"WOODBRIDGE","pcpstate":"VA","pcpzip":"22192-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7035800126,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F20.1","G40.909","G40.409","S00.91XA","E86.0","E87.2","D72.819","R00.1","V72.85","F84.0","Z91.048","R56.9","E78.5","D51.1","E55.9","F20.9","J30.9","J45.909","S05.01XA","H11.31","W01.198A","Z23.","Z91.14","Z79.899","F84.5","S05.91XA","K59.00","F39.","G47.00","H10.30","G43.009","J01.00","J20.9","R50.9","R06.2","S90.451A","S90.851A","W26.8XXA","F90.9","S99.921A","R55.","E04.1","S00.81XA","R51.9","W19.XXXA"],"date":["2021-01-12","2023-02-09","2021-10-04","2021-10-04","2021-10-04","2021-10-04","2023-01-18","2021-10-04","2021-10-04","2023-04-11","2023-02-09","2022-09-21","2022-11-02","2022-11-02","2023-01-18","2023-05-09","2023-04-11","2021-07-13","2023-02-09","2022-07-31","2022-07-31","2022-10-28","2023-02-09","2023-02-09","2023-02-09","2023-02-09","2022-02-09","2023-04-11","2022-01-25","2022-02-09","2022-02-09","2022-06-01","2022-06-01","2022-06-01","2022-06-01","2022-11-19","2022-11-19","2022-11-19","2021-03-18","2022-11-19","2023-02-09","2023-04-11","2022-07-03","2022-07-31","2023-02-09"],"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":[["","69097083412","SERTRALINE","TAB 50MG","30","Select","Select",""],["","68180011807","LEVETIRACETA","TAB 750MG ER","180","Select","Select",""],["","69452015120","VITAMIN D","2 1250 MCG","8","Select","Select",""],["","65162046650","IBUPROFEN","TAB 800MG","60","Select","Select",""],["","69452017173","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00054418325","DEXAMETHASON","TAB 2MG","5","Select","Select",""],["","60505058204","MOXIFLOXACIN","SOL HCL 0.5%","3","Select","Select",""],["","43547022315","LEVETIRACETAM","750 MG","60","Select","Select",""],["","69097083412","SERTRALINE HCL","50 MG","30","Select","Select",""],["","24208091055","ERYTHROMYCIN","5 MG\/GRAM","3.5","Select","Select",""],["","57237004705","DIVALPROEX SODIUM","250 MG","60","Select","Select",""],["","68180011807","LEVETIRACETAM ER","750 MG","180","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":""}]}]}