{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANA  R GUZMAN","gend":1,"add":"7142 AZALEA DR APT 201","city":"RUTHER GLEN","state":"VA","zip":"22546-9998","dob":"1965-12-11","age":"","mstatus":"","insh":"2128567*01","cliId":"","pno":7862272064,"cno":7862272064,"email":"","ename":"","eno":"","pphy":"SALES, BENEDICT MD","ppno":7035231750,"pcpadd":"3600 POINTE CENTER COURT STE 110","pcpcity":"DUMFRIES","pcpstate":"VA","pcpzip":"22026-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8445180708,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R06.02","R53.1","R06.4","Z20.822","D50.9","M05.79","I10.","M06.9","Z85.828","M85.80","M17.4","Z79.899","Z79.1","Z23.","R42.","H53.9","M54.6","R21.","R41.3","R11.11","Z79.52","H40.023","H43.811","G43.109","R19.7","Q04.8","S60.221A","M25.531","E46.","Z01.419","Z12.4","Z12.39","Z00.00","Z12.11","Z53.20","Z12.31","R00.0","R93.89","W01.0XXA","M06.09","M50.30","M85.89"],"date":["2021-07-17","2021-07-17","2021-07-17","2021-07-17","2023-01-18","2023-01-18","2023-01-18","2022-09-12","2021-07-13","2021-07-27","2021-07-13","2021-07-27","2021-07-27","2023-01-18","2022-02-07","2021-09-30","2021-09-30","2021-10-14","2021-09-30","2021-09-30","2021-03-25","2021-12-17","2021-12-17","2021-09-17","2022-02-07","2023-01-18","2022-09-12","2022-09-12","2023-01-18","2021-05-24","2021-05-24","2021-05-24","2022-04-06","2022-04-06","2022-04-06","2021-03-30","2021-07-17","2021-12-15","2022-09-12","2021-10-14","2021-10-14","2021-10-14"],"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":[["","68180051901","LISINOP\/HCTZ","TAB 20-12.5","90","Select","Select",""],["","00003218851","ORENCIA CLCK","INJ 125MG\/ML","4","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","60","Select","Select",""],["","50242013801","ACTEMRA","INJ 162\/0.9","2","Select","Select",""],["","00378064010","PREDNISONE","5 MG","30","Select","Select",""],["","59267102501","PFIZER VACC","INJ ADLT RTU","0","Select","Select",""],["","00378034505","DIAZEPAM","TAB 5MG","2","Select","Select",""],["","70710115703","LEFLUNOMIDE","TAB 10MG","90","Select","Select",""],["","00536100901","FERROUS SULF","TAB 325MG","30","Select","Select",""],["","00536408501","PRENATAL","TAB 28-0.8MG","30","Select","Select",""],["","43598072101","HYDROXYCHLOR","TAB 200MG","180","Select","Select",""],["","00003218851","ORENCIA CLICKJECT","125 MG\/ML","4","Select","Select",""],["","68180051901","LISINOPRIL-HYDROCHLOROTHIAZIDE","20-12.5 MG","90","Select","Select",""],["","49483060450","IBUPROFEN","800 MG","21","Select","Select",""],["","68180012202","CEPHALEXIN","500 MG","40","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":""}]}]}