{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   YENDORSIVRAJ F","gend":0,"add":"GDES 7046RD DLEIFE","city":"NORFOLK","state":"VA","zip":"23513-9998","dob":"1970-10-30","age":"","mstatus":"","insh":"74000910*319","cliId":"2N24HW8UE83","pno":"67\/7571542-1","cno":"757\/761-2451","email":"","ename":"","eno":"","pphy":"PAVON, HUMBERTO F MD","ppno":"757\/502-4840","pcpadd":"SUITE 101 5700 LAKE WRIGHT DR","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23502,"pcpcounty":"","pcpid":141130,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E78.5","I10.","R21.","G40.009","G40.909","F79.","F84.0"],"date":["2021-08-19","2021-08-19","2021-05-20","2021-10-27","2021-08-19","2021-08-19","2021-09-29"],"priorHcc":[null,null,"",null,null,null,null]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","13107015630","PAROXETINE HCL","","56","Select","Select",""],["","67877024610","QUETIAPINE FUMARATE","","84","Select","Select",""],["","832155011","HALOPERIDOL","","56","Select","Select",""],["","13668011790","LOSARTAN POTASSIUM\/HYDROCHLOROTHIAZIDE","","28","Select","Select",""],["","378116505","BUSPIRONE HCL ","","112","Select","Select",""],["","172392670","DIAZEPAM","","56","Select","Select",""],["","62037099910","POTASSIUM CHLORIDE ER","","28","Select","Select",""],["","93010910","CARBAMAZEPINE ","","168","Select","Select",""],["","16729000517","SIMVASTATIN","","28","Select","Select",""],["","904671772","CETIRIZINE HYDROCHLORIDE","","28","Select","Select",""],["","00378116505","BUSPIRONE HCL","","112","Select","Select",""],["","00536466110","THEREMS-M","","28","Select","Select",""],["","00472037045","BETAMETHASONE VALERATE","","45","Select","Select",""],["","00093010910","CARBAMAZEPINE","","168","Select","Select",""],["","00116200116","CHLORHEXIDINE GLUCONATE","0.12%","473","Select","Select",""],["","16729014917","QUETIAPINE FUMARATE                                                   ","TAB 300MG","28","Select","Select",""],["","13107015630","PAROXETINE HCL                                                        ","TAB 30MG","56","Select","Select",""],["","00378116505","BUSPIRONE HCL                                                         ","TAB 15MG","112","Select","Select",""],["","00832155011","HALOPERIDOL                                                           ","TAB 10MG","56","Select","Select",""],["","00172392670","DIAZEPAM                                                              ","TAB 5MG","56","Select","Select",""],["","13668011790","LOSARTAN POTASSIUM\/HYDROCHLOROTHIAZIDE                                ","TAB 100-12.5","28","Select","Select",""],["","00472037045","BETAMETHASONE VALERATE                                                ","CRE 0.001","45","Select","Select",""],["","00904671772","CETIRIZINE HYDROCHLORIDE                                              ","TAB 10MG","28","Select","Select",""],["","00093010910","CARBAMAZEPINE                                                         ","TAB 200MG","168","Select","Select",""],["","16729000517","SIMVASTATIN                                                           ","TAB 20MG","28","Select","Select",""],["","00536466110","THEREMS-M                                                             ","TAB ","28","Select","Select",""],["","62037099910","POTASSIUM CHLORIDE ER                                                 ","TAB 20MEQ ER","28","Select","Select",""],["","00116200116","CHLORHEXIDINE GLUCONATE                                               ","SOL 0.0012","473","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}