{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BLANCA AMBRIZ","gend":1,"add":"13721 JEFFERSON DAVIS HWY TRLR 1","city":"WOODBRIDGE","state":"VA","zip":"22191-9998","dob":"1962-08-28","age":"","mstatus":"","insh":"2139577*01","cliId":"","pno":5712603561,"cno":5712603561,"email":"","ename":"","eno":"","pphy":"WASIMUDDIN, KHALID MD","ppno":7034999966,"pcpadd":"SUITE 310 14904 JEFFERSON DAVIS,","pcpcity":"WOODBRIDGE","pcpstate":"VA","pcpzip":"22191-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7034998515,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E78.5","I10.","I87.2","F32.9","R14.0","N17.9","R79.89","N18.5","E11.649","E11.22","I12.0","J18.9","J90.","D63.1","Z86.16","Z74.3","R10.0","E87.70","D50.9","N25.81","E10.9","E78.2","J45.909","K21.9","Z03.818","H25.812","E55.9","E87.5","N18.9","E87.6","Z01.810","Z01.812","I25.10","Z20.822","D51.0","E04.9","E11.65","R06.83","H25.11","I86.8","H25.811","U07.1","R07.9","E10.10","J02.9","J30.9","G47.00","Z01.818","H25.12","E11.9","D64.9","Z71.9","Z49.01","R06.02","H26.9","N18.4","NO DATA","E66.9","E11.319","I13.2","J96.01","I50.31","E83.39","Z79.4","R60.9","M79.605","E11.3513","H43.12","H11.041","H16.223","N18.6","Z99.2","I42.9","K29.00","R10.10","R60.0","E78.00","M15.9","Z00.00"],"date":["2023-05-11","2023-05-11","2023-03-14","2023-02-21","2023-03-01","2023-03-13","2023-03-01","2023-03-13","2023-03-01","2023-03-13","2023-03-13","2023-03-01","2023-03-01","2023-03-13","2023-03-01","2023-03-02","2023-03-02","2023-03-13","2023-03-13","2023-03-13","2022-09-29","2022-09-29","2021-02-27","2022-11-10","2021-01-09","2021-01-28","2023-05-11","2023-03-02","2023-03-14","2022-03-10","2021-01-09","2021-01-09","2021-01-09","2021-01-09","2021-01-09","2021-01-09","2021-01-09","2021-01-09","2021-01-14","2022-09-29","2021-01-14","2021-05-11","2021-05-11","2022-07-25","2022-01-05","2023-05-11","2022-01-13","2021-01-12","2021-01-28","2023-02-28","2021-11-20","2021-12-18","2023-03-06","2023-03-06","2021-01-14","2023-03-02","2023-03-02","2023-03-02","2023-03-02","2023-03-02","2023-03-02","2023-03-02","2023-03-02","2023-03-02","2022-01-13","2022-04-06","2022-10-05","2022-10-05","2022-10-05","2022-10-05","2023-08-10","2023-08-01","2023-03-05","2023-02-28","2023-02-28","2023-02-28","2023-02-28","2023-02-28","2023-07-11"],"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":[["","69452015120","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","50228014610","HYDROCHLOROT","CAP 12.5MG","30","Select","Select",""],["","00002871501","HUMULIN","70-30 70-30\/ML","10","Select","Select",""],["","24208060203","PROLENSA","SOL 0.0007","3","Select","Select",""],["","60758011905","PREDNISOLONE","SUS 1% OP","5","Select","Select",""],["","00781713593","MOXIFLOXACIN","SOL HCL 0.5%","3","Select","Select",""],["","08290328466","INSULIN SYRG","MIS 0.5\/30G","100","Select","Select",""],["","31722052101","HYDRALAZINE","TAB 50MG","90","Select","Select",""],["","60505100301","KETOROLAC","SOL 0.005","5","Select","Select",""],["","17478071310","OFLOXACIN","DRO 0.3% OP","5","Select","Select",""],["","61442012101","FAMOTIDINE","20 MG","30","Select","Select",""],["","69230031203","ALLERGY RELF","TAB 10MG","30","Select","Select",""],["","55111015901","OMEPRAZOLE","40 MG","30","Select","Select",""],["","00378395105","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","00054429725","FUROSEMIDE","20 MG","30","Select","Select",""],["","16571041210","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","29300012501","MELOXICAM","TAB 15MG","30","Select","Select",""],["","16729022716","SPIRONOLACT","TAB 100MG","30","Select","Select",""],["","76282023890","AMLODIPINE","TAB 5MG","60","Select","Select",""],["","10702003615","SOD POLY SUL","POW ","15","Select","Select",""],["","51991070405","ALPRAZOLAM","TAB 0.25MG","15","Select","Select",""],["","45802004935","TRIAMCINOLON","OIN 0.005","30","Select","Select",""],["","00904685272","LORATADINE","10 MG","30","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00781261301","AMOXICILLIN","CAP 500MG","14","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","20","Select","Select",""],["","65162062711","TRAMADOL HCL","TAB 50MG","14","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","200","Select","Select",""],["","00781531701","ZOLPIDEM","TAB 5MG","30","Select","Select",""],["","00093506201","HYDROXYZ HCL","TAB 50MG","270","Select","Select",""],["","42806071501","BENZONATATE","CAP 200MG","21","Select","Select",""],["","68382009806","PAROXETINE","TAB 20MG","30","Select","Select",""],["","14613033972","QUICKVUE HOM","KIT COVID-19","2","Select","Select",""],["","14613033972","QUICKVUE AT-HOME COVID-","19 TEST","2","Select","Select",""],["","68382009806","PAROXETINE HCL","20 MG","30","Select","Select",""],["","08290328466","INSULIN SYRINGE","30GX1\/2\"","100","Select","Select",""],["","65162083366","DICLOFENAC SODIUM","1 %","200","Select","Select",""],["","00093505998","ATORVASTATIN CALCIUM","20 MG","30","Select","Select",""],["","45802004935","TRIAMCINOLONE ACETONIDE","0.5 %","30","Select","Select",""],["","43598047890","SEVELAMER CARBONATE","0.8 G","90","Select","Select",""],["","31722052201","HYDRALAZINE HCL","100 MG","90","Select","Select",""],["","76385011150","CARVEDILOL","6.25 MG","60","Select","Select",""],["","00093735201","CALCITRIOL","0.25 MCG","30","Select","Select",""],["","76282023890","AMLODIPINE BESYLATE","5 MG","60","Select","Select",""],["","00904759060","FEROSUL","325(65) MG","30","Select","Select",""],["","68382052601","BUMETANIDE","1 MG","60","Select","Select",""],["","00904699860","DOCUSATE SODIUM","100 MG","30","Select","Select",""],["","16729044010","CINACALCET HCL","30 MG","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":""}]}]}