{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"QIANFEI ZHAO","gend":1,"add":"25658 CABIN POINT CT","city":"CHANTILLY","state":"VA","zip":"20152-9998","dob":"1935-04-01","age":"","mstatus":"","insh":"20077938*01","cliId":"","pno":2027474977,"cno":2027474977,"email":"","ename":"","eno":"","pphy":"EZZEKMI-AKSOUH, FELLA PA","ppno":5716233477,"pcpadd":"2740 PROSPERITY AVE SUITE 300,","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":5716233482,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","I25.10","Z86.74","R07.9","M81.0","I20.8","K21.9","R00.2","L20.9","R07.89","NO DATA","G47.00","G70.00","R04.2","R05.9","G47.9","E04.1","I82.622","Z09.","Z79.01","Z86.718","R77.8","Z13.220","Z13.1","Z13.21","Z12.11","Z13.820","F41.9","Z76.89"],"date":["2022-08-25","2022-04-29","2022-04-29","2022-04-29","2022-08-25","2022-08-25","2022-08-25","2022-08-25","2022-08-25","2022-08-25","2022-08-25","2022-08-25","2022-08-25","2021-12-10","2021-12-10","2021-12-10","2021-12-10","2021-09-02","2021-09-02","2021-09-02","2021-09-02","2021-10-19","2021-11-19","2021-11-19","2021-11-19","2021-11-19","2021-11-19","2021-11-19","2021-11-16"],"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":[["","68462016201","CARVEDILOL TAB","3.125MG","60","Select","Select",""],["","50742017501","ISOSORB MONO TAB","30MG ER","90","Select","Select",""],["","16714063301","ALENDRONATE TAB","70MG","4","Select","Select",""],["","68682030130","PYRIDOSTIGMI TAB ER","180MG","30","Select","Select",""],["","50742024890","DILTIAZEM CAP","120MG ER","90","Select","Select",""],["","00093031801","DILTIAZEM TAB","30MG","90","Select","Select",""],["","63981045888","ALLER-TEC TAB","10MG","30","Select","Select",""],["","16714097901","ESOMEPRA MAG CAP","20MG DR","30","Select","Select",""],["","16729014601","QUETIAPINE TAB","50MG","90","Select","Select",""],["","69238153203","CLOBETASOL CRE","0.05%","30","Select","Select",""],["","00172572860","FAMOTIDINE TAB","20MG","30","Select","Select",""],["","13107000130","MIRTAZAPINE TAB","7.5MG","30","Select","Select",""],["","82607066028","FLOWFLEX KIT TEST","","5","Select","Select",""],["","62037059790","CARTIA XT CAP","120\/24HR","90","Select","Select",""],["","50742017501","ISOSORBIDE MONONITRATE ER","30 MG","90","Select","Select",""],["","68682030130","PYRIDOSTIGMINE BROMIDE ER","180 MG","30","Select","Select",""],["","16714063301","ALENDRONATE SODIUM","70 MG","4","Select","Select",""],["","68462016201","CARVEDILOL","3.125 MG","60","Select","Select",""],["","82607066028","FLOWFLEX COVID-","19 AG HOME TEST","5","Select","Select",""],["","62037059790","CARTIA XT","120 MG","90","Select","Select",""],["","29300014801","QUETIAPINE FUMARATE","50 MG","90","Select","Select",""],["","16714063301","ALENDRONATE","TAB 70MG","4","Select","Select",""],["","50742024890","DILTIAZEM","CAP 120MG ER","30","Select","Select",""],["","50742017501","ISOSORB MONO","TAB 30MG ER","30","Select","Select",""],["","68682030130","PYRIDOSTIGMI","TAB ER 180MG","30","Select","Select",""],["","63981045888","ALLER-TEC","TAB 10MG","30","Select","Select",""],["","16714097901","ESOMEPRA MAG","CAP 20MG DR","30","Select","Select",""],["","16729014601","QUETIAPINE","TAB 50MG","90","Select","Select",""],["","69238153203","CLOBETASOL","CRE 0.0005","30","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","90","Select","Select",""],["","82607066028","FLOWFLEX","KIT TEST","5","Select","Select",""],["","13107000130","MIRTAZAPINE","TAB 7.5MG","30","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":""}]}]}