{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DEREK   L SLOAN","gend":0,"add":"4508 ARENDALE SQ","city":"ALEXANDRIA","state":"VA","zip":"22309-9998","dob":"1987-07-15","age":"","mstatus":"","insh":"2180252*01","cliId":"","pno":5027169470,"cno":5027169470,"email":"","ename":"","eno":"","pphy":"JAMES, LAUREN J MD","ppno":5716656610,"pcpadd":"4700 KING ST STE 100","pcpcity":"ALEXANDRIA","pcpstate":"VA","pcpzip":"22302-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5716656611,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K21.9","R07.9","R10.9","R51.9","F41.9","Z21.","G89.29","NO DATA","B20.","Z11.59","Z11.3","Z11.1","A63.0","A60.00","N48.89","K44.9","Z12.11","K63.5","K29.70","R13.19","R93.3","R14.0","K59.09","K29.50","R13.10","K29.80","R07.89","Z23.","Z72.52","R11.0","S16.1XXA","G44.201","M62.838","B00.9","H18.623","H52.03","H52.223","R19.4","R13.14","D12.2","K62.1","K64.8"],"date":["2022-09-30","2022-10-12","2022-08-24","2022-07-19","2022-07-19","2022-07-19","2022-08-24","2022-12-30","2022-11-17","2021-05-03","2021-05-12","2021-05-03","2021-12-17","2021-05-12","2022-03-07","2022-03-07","2022-12-30","2022-12-30","2023-01-30","2022-08-24","2022-08-24","2022-12-30","2022-08-24","2022-12-30","2022-09-30","2022-12-30","2021-08-04","2021-12-17","2022-08-04","2022-08-04","2022-10-12","2022-10-12","2022-10-12","2022-11-17","2022-11-23","2022-11-23","2022-11-23","2022-12-30","2022-12-30","2022-12-30","2022-12-30","2022-12-30"],"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":[["","61958190101","GENVOYA","150-200-10","30","Select","Select",""],["","68382079101","ACYCLOVIR","400 MG","60","Select","Select",""],["","80777027399","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","70461032203","FLUCLVX QUAD","INJ 2022-23","0","Select","Select",""],["","68382050010","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","00093081001","NORTRIPTYLIN","CAP 10MG","30","Select","Select",""],["","27241009803","DULOXETINE","CAP 30MG","30","Select","Select",""],["","00116200116","CHLORHEX GLU","SOL 0.0012","473","Select","Select",""],["","00378668977","PANTOPRAZOLE","TAB 40MG","60","Select","Select",""],["","43386006019","GAVILYTE-C","SOL ","4000","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","11877001140","BINAXNOW COV","KIT HOME TES","8","Select","Select",""],["","57237002801","AMOXICILLIN","TAB 500MG","21","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","12","Select","Select",""],["","10135012310","ACETAMIN","TAB 325MG","30","Select","Select",""],["","00781185220","AMOX\/K CLAV","TAB 875-125","14","Select","Select",""],["","00536132701","ACETAMINOPHE","TAB 325MG","30","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","15","Select","Select",""],["","00363010412","PAIN RELIEVR","TAB 325MG","30","Select","Select",""],["","49281042250","FLUZONE QUAD","INJ 2022-23","0","Select","Select",""],["","00378668977","PANTOPRAZOLE SODIUM","40 MG","60","Select","Select",""],["","80777027399","MODERNA COVID (","12Y UP)VAC(EUA) 100MCG\/0.5","0.5","Select","Select",""],["","70461032203","FLUCELVAX QUAD","2022-2023 60MCG\/.5ML","0.5","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":""}]}]}