{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AGHA A ALIKHAN","gend":0,"add":"806 WILKINSON DR NE APT 202","city":"LEESBURG","state":"VA","zip":"20176-9998","dob":"1966-11-15","age":"","mstatus":"","insh":"2286784*01","cliId":"","pno":2027027990,"cno":2027027990,"email":"","ename":"","eno":"","pphy":"BECKWITH, ROSHELLE MD","ppno":7036874158,"pcpadd":"952 EDWARDS FERRY ROAD NE,","pcpcity":"LEESBURG","pcpstate":"VA","pcpzip":"20176-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7036874159,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","E78.5","Z71.2","L97.812","E11.622","R60.0","Z86.14","Z11.52","Z01.812","Z00.01","S66.319A","E11.65","F06.4","R01.1","H01.002","H01.001","H00.012","E11.8","F41.9","J01.20","A49.02","W51.XXXS","L08.9","J30.9","M77.12","E08.65","J20.9","E78.2","NO DATA","M25.80","Z79.4","E11.69","H10.011","G89.29","L03.115","N17.9","I96.","E86.0","E87.5","D64.9","G47.00","B95.62","Z79.84","Z98.1","Z83.3","L97.519","Z01.818","E11.59","L02.31","J01.90","L02.416","V58.89","M54.12","M96.1","R45.4","F06.31","L97.909","S81.801A","Z09.","Z87.2","J02.8","F06.30","J06.9"],"date":["2022-04-07","2022-03-03","2023-03-22","2022-04-07","2022-04-07","2022-04-07","2022-04-07","2022-10-12","2022-10-12","2021-03-01","2021-03-01","2023-03-22","2021-03-01","2021-03-01","2021-09-23","2021-09-23","2021-09-23","2022-04-16","2022-02-23","2021-09-23","2022-04-07","2022-04-07","2022-04-16","2023-03-04","2023-03-04","2023-03-04","2023-03-22","2023-03-04","2023-03-04","2023-03-04","2023-03-22","2023-03-22","2021-10-09","2022-09-29","2022-02-28","2022-02-28","2022-02-28","2022-02-23","2022-02-23","2022-02-23","2022-02-23","2022-10-06","2022-02-23","2022-09-29","2022-02-23","2022-02-26","2022-10-06","2022-02-28","2022-09-08","2021-11-12","2021-11-12","2022-09-08","2022-09-29","2022-09-29","2021-05-08","2021-05-08","2022-02-23","2022-02-28","2022-04-07","2022-04-07","2022-05-27","2022-05-27","2022-01-20"],"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":[["","72205002490","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","15","Select","Select",""],["","75834002001","VITAMIN D3","CAP 50000UNT","4","Select","Select",""],["","29300012401","MELOXICAM","TAB 7.5MG","60","Select","Select",""],["","65862019105","CYCLOBENZAPR","TAB 10MG","90","Select","Select",""],["","68180029706","DULOXETINE","CAP 40MG","30","Select","Select",""],["","51672131200","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","13107003134","MIRTAZAPINE","TAB 15MG","15","Select","Select",""],["","53885004601","ONETOUCH","KIT ULTRA 2","1","Select","Select",""],["","65702071210","ACCU-CHEK","TES GUIDE","100","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","100","Select","Select",""],["","50924095120","SAFE-T-PRO","MIS LANCETS","200","Select","Select",""],["","65702073110","ACCU-CHECK","KIT GUIDE ME","1","Select","Select",""],["","00006011231","JANUVIA","50 MG","90","Select","Select",""],["","16729016801","ESCITALOPRAM","TAB 5MG","30","Select","Select",""],["","42858011830","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","74312005535","MAGNESIUM","TAB 500MG","30","Select","Select",""],["","96295012827","MELATONIN","TAB 3MG","15","Select","Select",""],["","68462019001","NAPROXEN","500 MG","30","Select","Select",""],["","00193725201","CONTOUR","KIT NEXT EZ","1","Select","Select",""],["","56151146001","TRUE METRIX","TES GLUCOSE","100","Select","Select",""],["","71093012105","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","71093014004","METHOCARBAM","TAB 500MG","180","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","72205001390","PREGABALIN","75 MG","90","Select","Select",""],["","80777027399","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","00591024001","LORAZEPAM","TAB 0.5MG","12","Select","Select",""],["","57237023301","SMZ-TMP DS","TAB 800-160","20","Select","Select",""],["","00093314701","CEPHALEXIN","CAP 500MG","3","Select","Select",""],["","17478007035","ERYTHROMYCIN","OIN 5MG\/GM","4","Select","Select",""],["","00574402235","BACITRACIN","OIN OP","4","Select","Select",""],["","16714095501","KETOCONAZOLE","CRE 0.02","15","Select","Select",""],["","17478071310","OFLOXACIN","DRO 0.3% OP","5","Select","Select",""],["","65862041901","SMZ-TMP","TAB 400-80MG","28","Select","Select",""],["","16714039102","CEFDINIR","CAP 300MG","20","Select","Select",""],["","08317880125","TECHLITE","MIS LANCETS","100","Select","Select",""],["","00143980350","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","16714001401","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","43547035003","PAROXETINE","TAB 40MG","30","Select","Select",""],["","00955172805","INSULIN GLAR","INJ 100U\/ML","15","Select","Select",""],["","00603020922","MAG OXIDE","TAB 400MG","30","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","20","Select","Select",""],["","27241016430","DULOXETINE HCL","40 MG","90","Select","Select",""],["","65862001005","METFORMIN HCL","1000 MG","180","Select","Select",""],["","72205002490","ATORVASTATIN CALCIUM","40 MG","90","Select","Select",""],["","00603020922","MAGNESIUM OXIDE","400 MG","30","Select","Select",""],["","71093014004","METHOCARBAMOL","500 MG","180","Select","Select",""],["","68180015301","DESLORATADINE","5 MG","30","Select","Select",""],["","69367027204","CODEINE-GUAIFENESIN","10-100MG\/5","118","Select","Select",""],["","53191036201","D3","50 1250 MCG","12","Select","Select",""],["","08470115001","UNIFINE PENTIPS","31 GX3\/16\"","90","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","100\/ML (3)","15","Select","Select",""],["","69452017173","AZITHROMYCIN","250 MG","6","Select","Select",""],["","08470185001","UNIFINE PENTIPS PLUS","31 GX3\/16\"","90","Select","Select",""],["","75834002001","VITAMIN D","3 1250 MCG","4","Select","Select",""],["","00143980350","DOXYCYCLINE HYCLATE","100 MG","20","Select","Select",""],["","65862019105","CYCLOBENZAPRINE HCL","10 MG","30","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","53191036201","D","3-50 1250 MCG","4","Select","Select",""],["","57237023301","SULFAMETHOXAZOLE-TRIMETHOPRIM","800-160 MG","20","Select","Select",""],["","00955172805","INSULIN GLARGINE SOLOSTAR","100\/ML (3)","15","Select","Select",""],["","80777027399","MODERNA VAC INJ COVID-","19","0","Select","Select",""],["","16714039102","CEFDINIR CAP","300MG","20","Select","Select",""],["","00006011231","JANUVIA TAB","50MG","90","Select","Select",""],["","27241016430","DULOXETINE CAP","40MG","30","Select","Select",""],["","72205002490","ATORVASTATIN TAB","40MG","90","Select","Select",""],["","00088221905","LANTUS SOLOS INJ","100\/ML","15","Select","Select",""],["","68462019001","NAPROXEN TAB","500MG","60","Select","Select",""],["","53885004601","ONETOUCH KIT ULTRA","2","1","Select","Select",""],["","53885024510","ONETOUCH TES ULTRA","","100","Select","Select",""],["","53885004610","ONETOUCH MIS LANCETS","","100","Select","Select",""],["","08317880125","TECHLITE MIS LANCETS","","100","Select","Select",""],["","00193725201","CONTOUR KIT NEXT EZ","","1","Select","Select",""],["","57237023301","SMZ-TMP DS TAB","800-160","20","Select","Select",""],["","51672131200","MUPIROCIN OIN","2%","44","Select","Select",""],["","53885093701","ONETOUCH SOL ULT CONT","","1","Select","Select",""],["","00143980350","DOXYCYCL HYC CAP","100MG","20","Select","Select",""],["","00054327099","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","17478007035","ERYTHROMYCIN OIN","5MG\/GM","4","Select","Select",""],["","43547035003","PAROXETINE TAB","40MG","30","Select","Select",""],["","16729016801","ESCITALOPRAM TAB","5MG","30","Select","Select",""],["","00603020922","MAG OXIDE TAB","400MG","30","Select","Select",""],["","16714001401","AMOX\/K CLAV TAB","875-125","20","Select","Select",""],["","71093014004","METHOCARBAM TAB","500MG","180","Select","Select",""],["","00955172805","INSULIN GLAR INJ","100U\/ML","15","Select","Select",""],["","00093314701","CEPHALEXIN CAP","500MG","14","Select","Select",""],["","72205001390","PREGABALIN CAP","75MG","90","Select","Select",""],["","42858011830","LIDOCAINE PAD","5%","30","Select","Select",""],["","00406012301","HYDROCO\/APAP TAB","5-325MG","20","Select","Select",""],["","51672137002","MUPIROCIN CRE","2%","45","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":""}]}]}