{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARCELINA D GALDAMEZ SANDOVAL","gend":1,"add":"6354 SHAUNDALE DR","city":"SPRINGFIELD","state":"VA","zip":"22152-9998","dob":"1939-05-07","age":"","mstatus":"","insh":"20078270*01","cliId":"","pno":5714269101,"cno":5714269101,"email":"","ename":"","eno":"","pphy":"RAMALLO, JORGE A MD","ppno":5716656610,"pcpadd":"4700 KING STREET SUITE 100","pcpcity":"ALEXANDRIA","pcpstate":"VA","pcpzip":"22302-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5716656611,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H90.3","C91.00","R55.","I10.","C91.02","D61.810","K12.31","R73.9","T38.0X5A","T45.1X5A","E66.9","D61.9","E09.65","D70.9","D61.818","R50.81","R78.81","B96.20","Z79.899","Z79.2","D64.9","I73.9","I48.0","Z86.79","I25.118","I50.9","R06.02","E87.5","R09.02","Z20.822","J96.01","N17.8","J96.02","N17.9","I13.10","N18.4","R39.14","Z95.0","I21.4","S22.089A","R41.0","R26.81","R54.","N18.5","Z91.81","G89.11","V89.2XXA","NO DATA","I50.21","I48.91","I25.10","E11.22","S22.009A","E87.1","D63.1","A41.9","R65.21","I46.9","J98.11","Z51.89","I49.8","I49.3","R94.31","I50.23","E11.65","E03.9","Z79.4","I50.22","I44.7","I25.119","I25.5","J96.00","I63.9","G93.40","Z01.810","I65.23","Z79.52","Z68.34","E55.9","R57.9","C91.01","K59.00","R33.9","L98.8","R94.5","Z51.11","R13.10","E03.8","I42.8","I50.20","I44.1","R56.9","Z23.","I50.41","M10.9","D50.9","K59.09","R07.9","I11.0","I50.30","I42.9","I77.89","E11.9","E78.5","R06.00","I50.33","I42.0","I50.32","I70.211","J81.0","Z98.890","X58.XXXA","I70.213","R94.39","I13.2","N17.0","E87.4","Z75.1","I70.8","K21.9","R10.13","Z45.018","S22.081A","J96.21","J69.0","K72.00","Z51.5","Z66.","I13.0","N39.0","R06.89","I50.43","N18.9","Z01.812","I15.8","D84.9","R74.01","E80.6","F32.9","E11.69","I70.221","M54.9","Z71.89","G40.901","E78.6","Z13.820","T82.897A","R00.0","R93.89","I70.0","R74.8","L02.92","H90.5","Z68.54","Z99.89","I51.7","I34.0","R52.","R11.0","J18.1","I63.412","Z96.22","Z95.828","M1A.9XX0","K81.9"],"date":["2022-01-26","2022-04-20","2023-03-11","2023-03-17","2022-04-27","2022-04-14","2022-04-23","2022-04-01","2022-04-08","2022-04-23","2022-04-14","2022-04-14","2022-04-14","2022-04-27","2022-04-23","2022-04-27","2022-04-27","2022-04-23","2023-03-16","2022-04-27","2022-11-22","2022-12-02","2023-03-21","2022-11-09","2022-11-22","2023-03-12","2022-05-13","2023-03-17","2023-03-10","2022-05-13","2023-03-15","2022-05-17","2022-05-18","2023-03-25","2022-05-25","2022-08-31","2022-05-25","2023-03-21","2022-11-22","2023-03-21","2023-03-21","2023-03-21","2023-03-21","2023-03-05","2023-03-21","2023-03-05","2023-03-05","2023-03-20","2023-03-08","2023-03-08","2023-03-08","2023-03-08","2023-03-08","2023-03-17","2023-03-17","2023-03-11","2023-03-21","2023-03-25","2023-03-15","2023-03-19","2023-03-14","2023-03-14","2023-03-14","2023-03-21","2023-03-23","2023-03-23","2023-03-23","2023-03-21","2023-03-21","2023-03-21","2023-03-21","2023-03-25","2023-03-25","2023-03-25","2021-12-01","2022-01-13","2022-04-08","2022-03-04","2022-04-14","2023-03-20","2022-04-14","2022-04-18","2022-04-07","2022-04-11","2022-04-11","2022-04-14","2022-07-18","2022-07-18","2022-12-16","2023-03-06","2023-01-30","2023-03-19","2022-09-29","2022-05-18","2022-05-25","2022-11-22","2022-05-25","2023-03-11","2022-11-09","2022-11-09","2022-11-23","2022-11-09","2023-03-10","2022-11-09","2022-11-09","2022-11-22","2023-01-30","2023-01-30","2022-03-31","2022-05-18","2023-01-30","2023-03-04","2022-01-10","2022-01-28","2023-03-04","2023-03-04","2022-05-13","2022-05-13","2022-06-03","2022-08-10","2022-08-31","2022-12-16","2023-03-04","2023-03-04","2023-03-04","2023-03-17","2023-03-04","2023-03-04","2023-03-04","2023-03-04","2023-03-04","2023-03-05","2023-03-10","2022-02-02","2022-04-14","2022-04-14","2022-04-14","2022-04-14","2022-04-08","2022-05-13","2022-11-22","2022-11-22","2023-03-24","2023-03-20","2022-01-13","2022-02-23","2022-11-23","2023-03-19","2021-12-15","2022-01-28","2022-04-08","2022-04-08","2022-04-08","2022-04-08","2022-05-13","2023-03-06","2023-03-06","2023-03-10","2023-03-10","2023-03-21","2023-03-20","2022-04-01","2022-04-01","2022-12-06","2022-12-06"],"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":[["","31722052101","HYDRALAZINE","TAB 50MG","90","Select","Select",""],["","68382009405","CARVEDILOL","12.5 MG","180","Select","Select",""],["","16729044915","LEVOTHYROXIN","TAB 75MCG","90","Select","Select",""],["","00093505898","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","49035046708","ASPIRIN 81MG","CHE WABLE TABLETS","90","Select","Select",""],["","68645051654","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","72305007530","EUTHYROX","TAB 75MCG","90","Select","Select",""],["","00093206406","CILOSTAZOL","100 MG","60","Select","Select",""],["","50742017601","ISOSORB MONO","TAB 60MG ER","90","Select","Select",""],["","00904404073","ASPIRIN","81 MG","30","Select","Select",""],["","00169183702","NOVOLIN70\/30","INJ RELION","10","Select","Select",""],["","00169183711","NOVOLIN","INJ 70\/30","10","Select","Select",""],["","00003089321","ELIQUIS","2.5 MG","60","Select","Select",""],["","68462063945","NITROGLYCERN","SUB 0.4MG","25","Select","Select",""],["","00002880559","HUMULIN N","INJ U-100KWP","30","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","45802086803","POLYETH GLYC","POW 3350 NF","510","Select","Select",""],["","00904679480","ASPIRIN LOW","CHW 81MG","30","Select","Select",""],["","00005200010","PREVNAR 20","INJ ","0","Select","Select",""],["","59267102504","PFIZER VACC","INJ ADLT RTU","0","Select","Select",""],["","11523726803","MIRALAX","POW 3350 NF","24","Select","Select",""],["","08290320119","BD PEN NEEDL","MIS 31GX5MM","100","Select","Select",""],["","65862041901","SMZ-TMP","TAB 400-80MG","8","Select","Select",""],["","29033000305","SUCRALFATE","TAB 1GM","30","Select","Select",""],["","50111091701","TORSEMIDE","20 MG","60","Select","Select",""],["","16729022601","SPIRONOLACT","TAB 50MG","15","Select","Select",""],["","16714004112","ALLOPURINOL","100 MG","8","Select","Select",""],["","00002880559","HUMULIN N KWIKPEN","100\/ML (3)","30","Select","Select",""],["","50742017601","ISOSORBIDE MONONITRATE ER","60 MG","90","Select","Select",""],["","31722052101","HYDRALAZINE HCL","50 MG","90","Select","Select",""],["","68462063945","NITROGLYCERIN","0.4 MG","75","Select","Select",""],["","00093505798","ATORVASTATIN CALCIUM","80 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":""}]}]}