{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DIKEMBE PRIDE","gend":0,"add":"3806 RUSSELL RD APT A21","city":"ALEXANDRIA","state":"VA","zip":"22305-9998","dob":"1992-02-03","age":"","mstatus":"","insh":"9587837*01","cliId":"","pno":2026297633,"cno":2026297633,"email":"","ename":"","eno":"","pphy":"WANG, QIONG NP","ppno":7032373446,"pcpadd":"8221 WILLOW OAKS CORPORATE DRIVE LE","pcpcity":"FAIRFAX","pcpstate":"VA","pcpzip":"22031-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7033279355,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S02.91XA","Z23.","S09.90XA","R42.","S02.0XXA","F07.81","S01.112A","S01.111A","S01.01XA","F31.9","G40.909","J32.0","S61.214A","Z78.1","R41.82","V54.19","V58.89","G40.89","S01.512A","Z91.14","Z79.899","Z21.","R56.9","M54.2","R10.13","R79.89","F10.10","Z91.013","Z91.018","D69.9","Z20.822","Y09.","R11.2","Z11.3","T31.0","T21.16XA","Z72.0","F10.239","F41.9","F32.9","Z71.41","F39.","T44.3X1A","F31.4","F17.210","R94.31","R03.0","E55.9","F10.20","S01.00XA","X58.XXXA","NO DATA","M19.071","M20.5X1","M21.611","M79.671","M79.672","M21.612","G89.11","B20.","I49.8","F17.200","Z53.20","R07.9","T14.91XA","Z91.19","Z00.8","Z51.89","I10.","D17.79"],"date":["2022-01-13","2022-01-31","2022-07-08","2022-10-02","2022-01-12","2022-01-13","2022-01-12","2022-01-12","2022-01-30","2022-01-12","2022-01-14","2022-01-12","2022-01-12","2022-01-12","2022-01-12","2022-01-13","2022-01-13","2022-05-11","2022-05-11","2022-05-11","2022-05-11","2022-10-02","2023-04-24","2022-07-08","2022-09-28","2022-09-28","2022-09-30","2022-09-28","2022-09-28","2022-09-30","2023-02-01","2022-01-13","2023-02-01","2023-02-01","2023-02-01","2023-02-01","2023-04-24","2023-03-17","2023-03-17","2023-03-17","2023-03-17","2022-01-14","2022-01-14","2022-10-24","2022-10-02","2022-10-02","2022-10-02","2023-04-24","2023-03-23","2022-01-30","2022-01-30","2023-04-24","2023-03-09","2023-03-09","2023-03-09","2023-03-09","2023-03-09","2023-03-09","2022-01-30","2023-04-24","2022-09-30","2022-10-02","2022-01-11","2022-01-11","2022-01-14","2022-01-11","2022-10-02","2022-10-02","2023-04-24","2023-04-24"],"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":[["","61958250101","BIKTARVY","50-200-25","30","Select","Select",""],["","68180011507","LEVETIRACETA","TAB 1000MG","30","Select","Select",""],["","61269010556","BACITR ZINC","OIN 500UNIT","28","Select","Select",""],["","65862059401","DIVALPROEX","TAB 250MG ER","180","Select","Select",""],["","00536589688","NICOTINE TD","DIS 21MG\/24H","14","Select","Select",""],["","43547035311","LISINOPRIL","10 MG","30","Select","Select",""],["","16729008110","NALTREXONE","TAB 50MG","30","Select","Select",""],["","59779044874","CVS NICOTINE","DIS 21MG\/24H","14","Select","Select",""],["","67877021905","CEPHALEXIN","500 MG","40","Select","Select",""],["","68180011507","LEVETIRACETAM","1000 MG","30","Select","Select",""],["","00536589688","NICOTINE PATCH","21 MG\/24HR","14","Select","Select",""],["","80681005000","DAILY-VITE","400 MCG","14","Select","Select",""],["","00115180301","HYDROXYZINE PAMOATE","25 MG","20","Select","Select",""],["","16729008110","NALTREXONE HCL","50 MG","14","Select","Select",""],["","50111045001","TRAZODONE HCL","150 MG","14","Select","Select",""],["","00761055520","VITAMIN B-","1 100 MG","30","Select","Select",""],["","00536340501","NICOTINE GUM","4 MG","200","Select","Select",""],["","00406012301","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","12","Select","Select",""],["","00904673060","ACETAMINOPHEN","500 MG","24","Select","Select",""],["","00116200116","CHLORHEXIDINE GLUCONATE","0.12 %","473","Select","Select",""],["","59746000103","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","67877032005","IBUPROFEN","600 MG","28","Select","Select",""],["","00093310953","AMOXICILLIN","500 MG","21","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":""}]}]}