{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CINDY M TABOURN","gend":1,"add":"C\/O MRS LINDA TABOURN 14884 GRASSY KNOLL COURT APT 104","city":"WOODBRIDGE","state":"VA","zip":"22193-9998","dob":"1996-06-23","age":"","mstatus":"","insh":"2112897*01","cliId":"","pno":7036706895,"cno":7036706895,"email":"","ename":"","eno":"","pphy":"MOHIUDDIN, RASHID AHMED MD","ppno":7036807950,"pcpadd":"17739 MAIN STREET SUITE 130,","pcpcity":"DUMFRIES","pcpstate":"VA","pcpzip":"22026-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7036807953,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N93.9","R23.8","F17.210","Z88.8","R21.","R10.31","F33.1","R05.9","R53.83","J02.9","R09.81","R11.2","R51.9","B34.9","Z20.822","F17.200","N30.01","A60.04","V62.89","F43.10","Z86.16","Z90.89","Z79.899","L98.9","U07.1","J32.9","F41.9","F32.9","R35.0","N39.0","M79.641","F79.","Z86.59","Z87.820","Z62.810","Z98.890","M79.89","N91.2","R69.","R10.13","J01.90","Z11.52","R56.9","Z76.89","F44.9","R00.0","F06.1","Z20.2","N89.8","Z76.0","O02.81","Z30.9","Z30.011","N91.1","Z13.31","F31.9","R42.","H66.93","F44.5","F43.0","R50.9","R19.7","R30.0","Z32.02","S60.222A","M25.532","Z32.01","S46.811A","M25.512","X50.0XXA","R11.0"],"date":["2021-02-14","2022-09-28","2023-08-17","2022-11-06","2022-11-06","2023-01-29","2022-08-24","2022-07-06","2022-07-06","2022-07-06","2022-07-06","2023-01-28","2022-07-06","2022-07-06","2023-04-21","2022-07-06","2022-10-07","2022-10-07","2022-10-07","2022-10-09","2022-11-06","2022-10-07","2022-10-09","2022-10-07","2021-01-15","2021-01-08","2021-01-08","2021-01-08","2022-02-07","2022-02-07","2022-03-06","2022-11-06","2022-03-06","2022-03-06","2022-03-06","2022-03-06","2022-03-06","2022-03-21","2022-05-18","2022-10-09","2023-02-07","2023-04-21","2021-07-12","2021-10-21","2022-10-09","2022-05-14","2022-05-14","2022-11-06","2022-11-06","2022-11-06","2021-02-17","2021-02-17","2021-02-17","2022-05-18","2022-05-18","2022-10-09","2022-10-09","2021-04-19","2021-07-12","2021-07-12","2023-01-28","2023-01-28","2023-01-28","2023-01-28","2021-10-14","2021-10-14","2022-04-27","2023-08-17","2023-08-17","2023-08-17","2022-10-09"],"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":[["","47781030301","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","69097083512","SERTRALINE","TAB 100MG","30","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","30","Select","Select",""],["","00115180301","HYDROXYZ PAM","CAP 25MG","30","Select","Select",""],["","57664049983","MIRTAZAPINE","15 MG","30","Select","Select",""],["","14428000888","BACITR ZINC","OIN 500\/GM","14","Select","Select",""],["","59779050156","BACITRACIN","OIN 500\/GM","28","Select","Select",""],["","31722070530","VALACYCLOVIR","TAB 1GM","20","Select","Select",""],["","68382079201","ACYCLOVIR","TAB 800MG","50","Select","Select",""],["","53489011905","DOXYCYCL HYC","CAP 100MG","28","Select","Select",""],["","00555077902","MEDROXYPR AC","TAB 10MG","5","Select","Select",""],["","69097083512","SERTRALINE HCL","100 MG","30","Select","Select",""],["","50111056001","TRAZODONE HCL","50 MG","30","Select","Select",""],["","49483060350","IBUPROFEN","600 MG","20","Select","Select",""],["","70700011885","VIENVA","0.1-0.02MG","84","Select","Select",""],["","65862050320","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","14","Select","Select",""],["","47781030301","NITROFURANTN CAP","100MG","10","Select","Select",""],["","69097083512","SERTRALINE TAB","100MG","30","Select","Select",""],["","50111056001","TRAZODONE TAB","50MG","30","Select","Select",""],["","00115180301","HYDROXYZ PAM CAP","25MG","30","Select","Select",""],["","57664049983","MIRTAZAPINE TAB","15MG","30","Select","Select",""],["","00555077902","MEDROXYPR AC TAB","10MG","5","Select","Select",""],["","65862039010","ONDANSETRON TAB","4MG ODT","12","Select","Select",""],["","31722070530","VALACYCLOVIR TAB","1GM","20","Select","Select",""],["","59779050156","BACITRACIN OIN","500\/GM","28","Select","Select",""],["","14428000888","BACITR ZINC OIN","500\/GM","14","Select","Select",""],["","53489011905","DOXYCYCL HYC CAP","100MG","28","Select","Select",""],["","68382079201","ACYCLOVIR TAB","800MG","50","Select","Select",""],["","69097015807","MELOXICAM","7.5 MG","30","Select","Select",""],["","59746017710","CYCLOBENZAPRINE HCL","10 MG","20","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":""}]}]}