{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAQUEL TABRON","gend":1,"add":"1755 POWDER HORN TERRACE","city":"WOODBRIDGE","state":"VA","zip":"22191-9998","dob":"1980-08-25","age":"","mstatus":"","insh":"2112899*01","cliId":"","pno":5712646432,"cno":5712646432,"email":"","ename":"","eno":"","pphy":"VIYUOH, ADELINE MD","ppno":7036837220,"pcpadd":"325 S WASHINGTON ST,","pcpcity":"ALEXANDRIA","pcpstate":"VA","pcpzip":"22314-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7035357946,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.618","M25.511","M25.611","M75.01","E11.65","NO DATA","Z23.","H10.9","U07.1","E13.65","E87.1","E87.6","L02.31","V58.89","B37.3","R10.2","E11.9","N89.8","L29.2","Z92.29","R11.0","R19.7","K21.9","R10.13","K31.9","T39.395A","Z79.4","M25.561","M70.41","T14.8XXA","G89.29","Z11.52","J03.90","R03.0"],"date":["2021-06-01","2021-06-01","2021-06-01","2021-06-01","2022-10-11","2022-12-16","2021-06-21","2022-12-06","2021-12-22","2021-02-11","2021-02-11","2021-02-11","2021-02-11","2021-05-10","2021-09-14","2021-09-14","2021-09-14","2021-09-14","2021-09-14","2021-09-14","2022-10-11","2022-10-11","2022-10-11","2021-10-04","2021-10-04","2021-10-04","2021-10-04","2021-02-15","2021-02-15","2021-02-15","2021-06-01","2021-12-17","2023-06-22","2023-06-22"],"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":[["","65862050320","AMOX\/K CLAV","TAB 875-125","14","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","8","Select","Select",""],["","51672404806","CLOTRIM\/BETA","CRE DIPROP","45","Select","Select",""],["","70010049110","METFORMIN","TAB 500MG ER","60","Select","Select",""],["","53885024450","ONETOUCH","TES ULTRA","50","Select","Select",""],["","08290320109","BD PEN NEEDL","MIS 31GX8MM","100","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","15","Select","Select",""],["","00002771559","BASAGLAR","INJ 100UNIT","15","Select","Select",""],["","89158500500","CAREFINE","MIS 32GX5MM","200","Select","Select",""],["","00169406013","VICTOZA","3-PAK 0.6 MG\/0.1","27","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","72578008802","NYSTAT\/TRIAM","OIN ","60","Select","Select",""],["","57599000101","FREESTYLE","KIT SENSOR","2","Select","Select",""],["","00472016630","NYSTATIN","OIN 100000","30","Select","Select",""],["","00093310905","AMOXICILLIN","500 MG","20","Select","Select",""],["","00168000615","TRIAMCINOLON","OIN 0.001","30","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","75788011504","BREXAFEMME","TAB 150MG","4","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","60","Select","Select",""],["","60505056000","OFLOXACIN","DRO 0.3% OP","5","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","14","Select","Select",""],["","00603188016","LIDOCAINE","5 %","14","Select","Select",""],["","00093342210","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","00002771559","BASAGLAR KWIKPEN U-","100 100\/ML (3)","15","Select","Select",""],["","53885024510","ONETOUCH ULTRA TEST STRIP","","200","Select","Select",""],["","65862085901","FAMOTIDINE TAB","20MG","30","Select","Select",""],["","65862039010","ONDANSETRON TAB","4MG ODT","20","Select","Select",""],["","53746010901","HYDROCO\/APAP TAB","5-325MG","12","Select","Select",""],["","60505056001","OFLOXACIN DRO","0.3% OP","10","Select","Select",""],["","00093342210","CYCLOBENZAPR TAB","10MG","15","Select","Select",""],["","00603188016","LIDOCAINE PAD","5%","10","Select","Select",""],["","00093031401","KETOROLAC TAB","10MG","14","Select","Select",""],["","69315027520","DICLOFENAC POTASSIUM","25 MG","60","Select","Select",""],["","72888001400","CYCLOBENZAPRINE HCL","10 MG","30","Select","Select",""],["","76385012350","METHOCARBAMOL","500 MG","15","Select","Select",""],["","42858010201","OXYCODONE-ACETAMINOPHEN","5 MG-325MG","6","Select","Select",""],["","00378064205","PREDNISONE","20 MG","12","Select","Select",""],["","16571020106","DICLOFENAC SODIUM","75 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":""}]}]}