{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ASHOK BARAL","gend":0,"add":"4505 COTSWOLD MANOR LOOP","city":"WOODBRIDGE","state":"VA","zip":"22192-9998","dob":"1956-04-02","age":"","mstatus":"","insh":"2499723*01","cliId":"","pno":7037121916,"cno":7037121916,"email":"","ename":"","eno":"","pphy":"SINGH, GURWINDER MD","ppno":7035231720,"pcpadd":"2280 OPITZ BLVD STE 250","pcpcity":"WOODBRIDGE","pcpstate":"VA","pcpzip":"22191-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8552102389,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C90.30","Z23.","I10.","Z91.81","E78.2","K21.9","Z79.899","N40.0","Z86.010","Z11.59","C90.20","E78.5","J90.","M85.80","R76.8","R05.9","Z15.09","Z90.49","Z90.79","L85.3","J30.89","Z13.1","M25.561"],"date":["2023-04-14","2023-04-10","2023-04-10","2023-04-10","2023-04-10","2023-04-10","2023-02-28","2023-04-10","2022-10-10","2022-10-10","2023-04-14","2023-02-28","2023-02-28","2023-02-28","2023-02-28","2023-04-10","2023-02-28","2023-02-28","2023-02-28","2023-04-10","2023-04-10","2023-04-10","2023-04-10"],"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":[["","50228014601","HYDROCHLOROT","CAP 12.5MG","30","Select","Select",""],["","58487001003","VITAMIN C","500 MG","90","Select","Select",""],["","62175011832","OMEPRAZOLE","20 MG","30","Select","Select",""],["","43547035410","LISINOPRIL","20 MG","90","Select","Select",""],["","00536123441","ASPIRIN LOW","TAB 81MG EC","30","Select","Select",""],["","16714069803","VALACYCLOVIR","500 MG","30","Select","Select",""],["","16714071301","TAMSULOSIN","CAP 0.4MG","30","Select","Select",""],["","69452015120","VITAMIN D","2 1250 MCG","12","Select","Select",""],["","16714017401","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","00378081001","HYDROCHLOROTHIAZIDE","12.5 MG","30","Select","Select",""],["","72603011501","TAMSULOSIN HCL","0.4 MG","90","Select","Select",""],["","00904675180","ASPIRIN EC","81 MG","30","Select","Select",""],["","16714017401","ATORVASTATIN CALCIUM","20 MG","30","Select","Select",""],["","00093770198","LEVOCETIRIZINE DIHYDROCHLORIDE","5 MG","30","Select","Select",""],["","42806071401","BENZONATATE","100 MG","30","Select","Select",""],["","45334031016","VANICREAM","","453","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":""}]}]}