{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TIARA M HARRIS","gend":1,"add":"1791 POWDER HORN TERRACE TERRACE","city":"WOODBRIDGE","state":"VA","zip":"22191-9998","dob":"1985-05-07","age":"","mstatus":"","insh":"2205219*01","cliId":"","pno":5719310169,"cno":5719310169,"email":"","ename":"","eno":"","pphy":"KULKARNI, SONALEE MD","ppno":7038451500,"pcpadd":"SUITE 300 1500 N BEAUREGARD STREET,","pcpcity":"ALEXANDRIA","pcpstate":"VA","pcpzip":"22311-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7038451300,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I46.9","J96.01","J96.02","K72.00","G93.1","N17.9","J69.8","V58.89","I46.8","F11.10","R13.10","F17.210","H61.22","R00.1","R39.15","Z88.1","Z88.0","Z82.49","Z81.3","Z56.0","Z79.899","K14.9","K11.21","O29.211","G94.","Z30.42","Z20.2","T40.2X1A","E11.649","E43.","I50.21","J69.0","E87.2","Z68.1","B95.5","B96.4","Z20.822","E16.2","R94.31","R77.8","R79.89","G93.40","I38.","F41.9","Z74.3","Z74.09","R26.89","Z23.","K59.04","Z91.89","G47.01","R41.82","S06.2X9A","R49.0","G47.00","NO DATA","T65.92XA","R56.9","Z72.51","Z30.013"],"date":["2021-09-15","2021-09-07","2021-09-07","2021-09-07","2022-10-31","2021-09-15","2021-09-15","2021-12-15","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-09-30","2021-09-28","2021-10-26","2021-10-26","2022-07-21","2021-01-15","2021-08-27","2021-08-26","2021-08-27","2021-08-27","2021-08-27","2021-08-27","2021-08-27","2021-08-27","2021-08-27","2021-08-27","2021-08-27","2021-08-29","2021-08-29","2021-09-04","2021-09-16","2021-08-28","2022-07-11","2021-09-15","2021-09-15","2021-09-15","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2021-08-30","2021-09-21","2021-09-30","2021-10-05","2021-10-05","2021-08-26","2021-08-29","2022-01-07","2022-01-07"],"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":[["","16714045301","QUETIAPINE","TAB 50MG","30","Select","Select",""],["","45963043963","CONSTULOSE","SOL 10GM\/15","946","Select","Select",""],["","61442012110","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","00115180301","HYDROXYZ PAM","CAP 25MG","30","Select","Select",""],["","00548540000","MEDROXYPR AC","INJ 150MG\/ML","1","Select","Select",""],["","16714080901","NEW DAY","TAB 1.5MG","1","Select","Select",""],["","00904546080","OYST SHELL\/D","TAB 500MG","90","Select","Select",""],["","29300014801","QUETIAPINE FUMARATE","50 MG","30","Select","Select",""],["","00904546080","OYSTER SHELL CALCIUM-VIT D","3 500MG-5MCG","30","Select","Select",""],["","00115180301","HYDROXYZ PAM CAP","25MG","30","Select","Select",""],["","00548540000","MEDROXYPR AC INJ","150MG\/ML","1","Select","Select",""],["","16714080901","NEW DAY TAB","1.5MG","1","Select","Select",""],["","16714045302","QUETIAPINE TAB","50MG","30","Select","Select",""],["","00904546080","OYST SHELL\/D TAB","500MG","90","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":""}]}]}