{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"FRANZ S ORTIZ","gend":0,"add":"108 ROMNEY PL APT 1","city":"STEPHENS CITY","state":"VA","zip":"22655-9998","dob":"1971-01-10","age":"","mstatus":"","insh":"2244684*01","cliId":"","pno":7039919617,"cno":7039919617,"email":"","ename":"","eno":"","pphy":"AGYEIWAAH, MAVIS A MD","ppno":5405365400,"pcpadd":"1440 AMHERST ST,","pcpcity":"WINCHESTER","pcpstate":"VA","pcpzip":"22601-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5405365490,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R51.9","R42.","J30.9","M54.2","G44.209","R00.2","G44.221","I49.8","J32.9","E21.3","E34.9","Z87.442","H92.01","Z91.09","H53.8","I10.","E78.2","E66.9","Z11.3","R07.89","E83.52","S39.012A","NO DATA","X50.1XXA","N20.0","E78.5","Z79.82","R07.9","R10.11","R10.31","R00.1","M54.9","Z74.3"],"date":["2022-05-26","2023-09-15","2021-06-21","2022-05-26","2021-09-23","2021-06-08","2021-08-22","2021-04-20","2021-09-02","2022-07-18","2022-07-18","2022-07-18","2021-03-29","2021-03-29","2021-03-29","2023-09-15","2021-03-29","2021-03-29","2021-03-29","2021-06-14","2022-06-17","2023-08-07","2023-08-07","2023-08-07","2021-08-22","2023-09-15","2021-08-22","2023-09-15","2021-08-22","2021-08-22","2023-09-15","2023-08-07","2023-08-07"],"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":[["","70954005920","PREDNISONE","TAB 10MG","21","Select","Select",""],["","00168016330","CLOBETASOL","CRE 0.0005","30","Select","Select",""],["","69097015907","MELOXICAM","15 MG","30","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","59779074601","NASAL ALLRGY","SPR 55MCG\/AC","17","Select","Select",""],["","00093310905","AMOXICILLIN","500 MG","21","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00168016360","CLOBETASOL PROPIONATE","0.05 %","60","Select","Select",""],["","75834002001","VITAMIN D","3 1250 MCG","12","Select","Select",""],["","45802049383","AMMONIUM LACTATE","12 %","420","Select","Select",""],["","65862085430","AMLODIPINE-OLMESARTAN","5 MG-20 MG","90","Select","Select",""],["","59651036105","IBUPROFEN","600 MG","20","Select","Select",""],["","33342017910","OLMESARTAN MEDOXOMIL","20 MG","90","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","00093031401","KETOROLAC TROMETHAMINE","10 MG","15","Select","Select",""],["","59267140402","PFIZER COVID BIVAL (12Y UP)","EUA","0.3","Select","Select",""],["","65862019105","CYCLOBENZAPRINE HCL","10 MG","20","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":""}]}]}