{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMEL H ALI","gend":1,"add":"1005 PECONIC LN APT 301","city":"FREDERICKSBURG","state":"VA","zip":"22401-9998","dob":"1987-07-02","age":"","mstatus":"","insh":"2227334*01","cliId":"","pno":3046207844,"cno":3046207844,"email":"","ename":"","eno":"","pphy":"MIR, PAYAM MD","ppno":7033724429,"pcpadd":"11213 LEE HWY STE H,","pcpcity":"FAIRFAX","pcpstate":"VA","pcpzip":"22030-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7036890077,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K64.4","F90.0","Z30.41","Z71.3","E66.09","Z68.29","S93.401A","S93.601A","S80.212A","X58.XXXA","Y92.89","Y93.89","C85.81","Z87.891","Z80.8","Z88.6","Z79.891","R59.1","R59.0","K08.9","F41.1","B37.0","K02.7","K21.9","M26.609","E03.9","H93.293","H92.03","M25.50","E66.3","F90.9","R76.8","E55.9","S99.921A","U07.1","R07.9","R05.9","R22.1","R11.0","Z20.822","F43.10","C85.10","F41.0","F41.9","Z76.0","C85.11","C79.89","Z85.72","J30.2","NO DATA","D50.9","K64.8","R10.9","M79.641","M79.671","I73.00","R53.83","R20.2","M79.642","M79.672","J10.1","R50.9","N30.01","R87.619","Z13.89","S61.001A","W54.0XXA","M25.549","K90.41","F43.12","M19.90","R61.","R63.4","F90.2"],"date":["2021-07-14","2021-09-23","2021-04-22","2021-06-29","2021-06-29","2021-06-29","2022-11-21","2022-11-21","2022-11-21","2022-11-21","2022-11-21","2022-11-21","2021-09-24","2021-01-21","2021-01-21","2021-01-21","2021-01-21","2021-06-15","2021-02-02","2021-02-02","2022-06-13","2021-04-23","2021-04-23","2021-09-24","2021-09-24","2021-08-31","2021-08-31","2021-08-31","2021-11-05","2021-11-05","2022-02-01","2022-05-13","2022-02-03","2022-11-21","2023-01-05","2023-01-05","2023-01-05","2021-01-29","2021-01-07","2022-03-24","2021-12-10","2021-01-21","2021-02-25","2021-06-03","2021-02-25","2021-02-04","2021-01-21","2021-01-21","2021-01-29","2021-11-29","2021-11-29","2021-11-29","2021-11-29","2022-03-28","2022-03-28","2022-03-28","2022-03-10","2022-03-10","2022-03-28","2022-03-28","2022-03-24","2022-03-24","2023-01-27","2023-03-28","2021-08-26","2021-03-30","2021-03-30","2021-09-23","2021-09-23","2021-09-23","2022-05-13","2022-05-13","2022-05-13","2022-06-13"],"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":[["","42858000201","OXYCODONE","TAB 10MG","21","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","28","Select","Select",""],["","42858010301","OXYCOD\/APAP","TAB 7.5-325","15","Select","Select",""],["","54092039101","ADDERALL XR","30 MG","30","Select","Select",""],["","00228306111","AMPHET\/DEXTR","CAP 30MG ER","30","Select","Select",""],["","00093083205","CLONAZEPAM","0.5 MG","80","Select","Select",""],["","65862085901","FAMOTIDINE","20 MG","180","Select","Select",""],["","00378647099","SCOPOLAMINE","DIS 1MG\/3DAY","2","Select","Select",""],["","10019055304","TRANSDERM-SC","DIS 1MG\/3DAY","2","Select","Select",""],["","70436001102","BUPROPN HCL","TAB 300MG XL","90","Select","Select",""],["","00378064110","PREDNISONE","10 MG","63","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","180","Select","Select",""],["","62559043130","HYDROCORTISO","CRE 0.025","30","Select","Select",""],["","16571040250","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","68180083773","TRI-LO-","TAB MARZIA","84","Select","Select",""],["","60432053760","NYSTATIN","SUS 100000","240","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","40","Select","Select",""],["","59779045806","CVS ALLERGY","TAB 10MG","30","Select","Select",""],["","57237002801","AMOXICILLIN","TAB 500MG","30","Select","Select",""],["","59267100002","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","00116200116","CHLORHEX GLU","SOL 0.0012","473","Select","Select",""],["","70436005901","BUPROPION","TAB 150MG SR","30","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","49281042150","FLUZONE QUAD","INJ 2021-22","0","Select","Select",""],["","69452015120","VITAMIN D","2 1250 MCG","15","Select","Select",""],["","80681000900","VITAMIN D3","CAP 50MCG","90","Select","Select",""],["","50428016183","CVS D3","CAP 2000UNIT","90","Select","Select",""],["","57844010501","ADDERALL","TAB 5MG","5","Select","Select",""],["","69238126601","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","00006412102","GARDASIL 9","INJ ","0","Select","Select",""],["","43598072101","HYDROXYCHLOR","TAB 200MG","60","Select","Select",""],["","00555095202","DEXTROAMPHET","TAB 5MG","5","Select","Select",""],["","19515080852","FLULAVAL QUA","INJ 2022-23","0","Select","Select",""],["","00093005805","TRAMADOL HCL","TAB 50MG","10","Select","Select",""],["","00228306111","DEXTROAMPHETAMINE-AMPHET ER","30 MG","30","Select","Select",""],["","00185209801","DEXTROAMPHETAMINE-AMPHETAMINE","5 MG","30","Select","Select",""],["","69367017401","HYDROQUINONE","4 %","28.35","Select","Select",""],["","70700011885","VIENVA","0.1-0.02MG","84","Select","Select",""],["","64380071207","BENZONATATE","100 MG","21","Select","Select",""],["","50428052130","COVID-","19 AT-HOME TEST","8","Select","Select",""],["","65862042005","SULFAMETHOXAZOLE-TRIMETHOPRIM","800-160 MG","20","Select","Select",""],["","16571040250","CETIRIZINE HCL","10 MG","90","Select","Select",""],["","53191036201","D","3-50 1250 MCG","30","Select","Select",""],["","00093083205","CLONAZEPAM TAB","0.5MG","80","Select","Select",""],["","70436005901","BUPROPION TAB","150MG SR","30","Select","Select",""],["","16571040250","CETIRIZINE TAB","10MG","30","Select","Select",""],["","62175061743","PANTOPRAZOLE TAB","40MG","180","Select","Select",""],["","62559043130","HYDROCORTISO CRE","2.5%","30","Select","Select",""],["","65862085901","FAMOTIDINE TAB","20MG","180","Select","Select",""],["","59779045806","CVS ALLERGY TAB","10MG","30","Select","Select",""],["","54092039101","ADDERALL XR CAP","30MG","30","Select","Select",""],["","00228306111","AMPHET\/DEXTR CAP","30MG ER","30","Select","Select",""],["","50428016183","CVS D","3 CAP 2000UNIT","90","Select","Select",""],["","69452015120","VITAMIN D CAP","50000UNT","4","Select","Select",""],["","59746000103","METHYLPRED TAB","4MG","21","Select","Select",""],["","57844010501","ADDERALL TAB","5MG","5","Select","Select",""],["","00185209801","AMPHET\/DEXTR TAB","5MG","30","Select","Select",""],["","00006412102","GARDASIL","9 INJ","0","Select","Select",""],["","68462010530","ONDANSETRON TAB","4MG","28","Select","Select",""],["","00378064110","PREDNISONE TAB","10MG","30","Select","Select",""],["","43598072101","HYDROXYCHLOR TAB","200MG","60","Select","Select",""],["","00555095202","DEXTROAMPHET TAB","5MG","5","Select","Select",""],["","69238126601","OSELTAMIVIR CAP","75MG","10","Select","Select",""],["","19515080852","FLULAVAL QUA INJ","2022-23","0","Select","Select",""],["","00093005805","TRAMADOL HCL TAB","50MG","10","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":""}]}]}