{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AFEWORK ZEREAEGZI","gend":0,"add":"643 EDSALL ROAD","city":"ALEXANDRIA","state":"VA","zip":"22312-9998","dob":"1965-09-15","age":"","mstatus":"","insh":"2420308*01","cliId":"","pno":5712775031,"cno":5712775031,"email":"","ename":"","eno":"","pphy":"GREWAL, MANJOT MD","ppno":7035043000,"pcpadd":"4320 SEMINARY ROAD","pcpcity":"ALEXANDRIA","pcpstate":"VA","pcpzip":"22304-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7035043388,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K31.819","K92.0","T78.40XA","K31.7","K44.9","N17.9","E87.1","E80.6","E87.2","R10.84","Z74.3","R56.9","F10.231","Z72.89","E46.","F10.120","M79.604","G93.40","I10.","E11.65","Z78.9","R07.9","K92.2","N18.2","K76.7","E87.5","D64.9","R79.89","R94.5","R17.","P59.9","R10.9","F10.10","R11.2","NO DATA","M48.54XA","F10.129","K70.10","D69.6","D63.8","Z51.5","Z66.","Z20.822","E88.09","E87.6","E83.42","E83.39","F17.200","S22.000A","R41.82","Z71.89","Z87.891","F10.20","G93.41","J69.0","K85.20","E87.3","E44.0","K70.30","E11.43","K31.84","E11.649","K76.0","D69.59","M79.661","M79.662","M62.81","R74.01","Z59.00","R74.8","S02.842A","R10.11","G93.89","M25.551","M79.605","R50.9","K74.60","I95.9","E83.51","R94.01","F10.229","I50.31","E87.0","I11.0","F10.239","Z91.14","E86.9","Z88.8","R73.9","Z68.21","D50.9","R94.31","I11.9","E78.5","R11.10","R60.0","K57.30","J90.","I50.9","K29.20","R10.13","R10.12","G89.29","F10.220","Y90.8","R93.3","K29.00"],"date":["2022-08-02","2022-08-10","2022-08-02","2022-08-02","2022-08-02","2022-08-17","2023-04-17","2022-08-17","2022-08-19","2022-11-16","2022-11-18","2022-11-20","2022-08-10","2022-08-10","2022-08-10","2023-04-17","2022-10-15","2023-03-20","2023-03-23","2022-11-20","2022-11-20","2023-03-23","2022-08-01","2022-08-01","2022-08-01","2022-08-01","2022-08-19","2023-03-22","2022-08-05","2022-08-05","2022-08-05","2023-03-22","2022-08-05","2022-08-05","2022-11-19","2022-07-10","2022-07-10","2023-03-20","2023-04-17","2022-07-10","2022-07-12","2022-07-10","2023-03-20","2022-07-10","2023-04-17","2023-03-20","2022-07-10","2022-07-10","2022-07-12","2022-07-31","2022-07-12","2022-11-18","2022-11-20","2022-07-31","2022-07-31","2022-07-31","2022-07-31","2023-03-20","2022-07-31","2022-07-31","2022-07-31","2022-07-31","2023-03-20","2022-07-31","2022-10-14","2022-07-31","2022-07-31","2023-04-17","2022-07-31","2023-04-17","2022-11-16","2022-11-16","2022-07-31","2022-07-31","2022-07-31","2022-07-31","2022-07-31","2022-08-13","2022-08-13","2022-11-19","2023-03-20","2023-03-20","2023-04-17","2023-03-20","2023-03-20","2023-03-20","2023-03-20","2023-03-20","2023-03-20","2023-03-20","2023-03-21","2023-03-23","2023-03-23","2023-03-23","2023-03-22","2023-03-20","2023-03-20","2023-03-20","2023-03-20","2023-04-17","2023-04-17","2023-03-21","2023-03-21","2023-04-17","2023-03-21","2023-03-21","2023-04-17"],"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":[["","69315012710","FOLIC ACID","1 MG","30","Select","Select",""],["","57896050410","ONE-DAILY","TAB MULT VIT","30","Select","Select",""],["","00603020922","MAG OXIDE","TAB 400MG","10","Select","Select",""],["","10006070011","VITAMIN B1","TAB 100MG","30","Select","Select",""],["","65862056090","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","00378363205","CARVEDILOL","TAB 6.25MG","60","Select","Select",""],["","64980052810","SODIUM BICAR","TAB 650MG","10","Select","Select",""],["","65862024605","LEVETIRACETA","TAB 500MG","60","Select","Select",""],["","65162010150","GABAPENTIN","CAP 100MG","90","Select","Select",""],["","43547040211","FUROSEMIDE","40 MG","30","Select","Select",""],["","80681005000","DAILY-VITE","400 MCG","30","Select","Select",""],["","00904679480","ASPIRIN","81 MG","30","Select","Select",""],["","70377002911","ATORVASTATIN CALCIUM","40 MG","30","Select","Select",""],["","31604001281","VITAMIN B-","1 100 MG","30","Select","Select",""],["","50742061610","METOPROLOL SUCCINATE","50 MG","60","Select","Select",""],["","00536589488","NICOTINE PATCH","7MG\/24HR","14","Select","Select",""],["","23155000201","HYDRALAZINE HCL","25 MG","60","Select","Select",""],["","00378668910","PANTOPRAZOLE SODIUM","40 MG","30","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":""}]}]}