{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"T NIMSAJNOSPMOH","gend":1,"add":"GROEG GNIK 281 TPA YAUQ E","city":"CHESAPEAKE","state":"VA","zip":"23325-9998","dob":"1990-04-30","age":"","mstatus":"","insh":"9259110*29","cliId":"","pno":"64\/4076212-6","cno":"","email":"","ename":"","eno":"","pphy":"NGUYEN, VAN T MD","ppno":"757\/548-0076","pcpadd":"725 VOLVO PKWY","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":"","pcpname":"Nowcare Volvo","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","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":["E66.9","F33.1","F43.10","F41.9","F32.9","J30.1","J30.89","J30.81","J32.9","H10.45","L20.84","R56.9","R25.1","Z79.899","Z88.1","Z20.822","J34.89","R06.7","L30.9","R05.9","R09.82","R21.","M54.30","Z20.828","R50.9","H16.141","L03.012","B37.3","N76.0","R00.1","N89.8","L40.9","H10.33","L21.9","Z71.9","H16.011","H18.831","Z71.89","R51.","H16.142","Z01.89","Z12.4","Z11.3","D64.9","E55.9","G43.909","F32.2","A60.04","B35.0","U07.1","G47.00","B00.9","L21.0","H57.10","Z00.00","NO DATA","J06.9","Z23.","R06.02","D24.2","B96.89","B35.4","R06.09","Z01.419","R63.5"],"date":["2021-04-21","2020-04-21","2020-04-21","2021-04-21","2020-08-24","2021-05-06","2021-05-06","2021-04-23","2021-05-06","2021-06-25","2021-04-23","2021-10-02","2021-10-02","2021-10-28","2021-10-02","2021-10-28","2021-10-28","2021-10-28","2021-11-30","2021-10-28","2021-10-28","2021-10-28","2020-02-24","2020-08-14","2020-08-14","2021-05-24","2021-09-12","2021-09-12","2021-09-12","2021-10-02","2020-02-18","2020-02-18","2021-04-14","2021-11-30","2021-11-30","2021-04-20","2021-06-25","2020-05-20","2020-08-14","2021-04-20","2021-04-21","2021-04-21","2021-04-21","2021-04-21","2021-04-21","2020-01-21","2021-04-21","2021-04-21","2021-04-21","2020-08-14","2020-08-24","2020-08-24","2020-08-24","2021-04-14","2021-04-14","2019-02-13","2019-12-05","2019-12-05","2019-01-23","2019-02-13","2019-09-19","2019-09-20","2019-01-23","2019-01-23","2019-01-23"],"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":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","","CITALOPRAM","TAB 10MG","","Select","Select",""],["","","CLOBETASOL","SOL 0.0005","","Select","Select",""],["","","PHENTERMINE"," PHENTERMINE ","30","Select","Select",""],["","00093598627","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","","BUPROPION","TAB 150MG SR","","Select","Select",""],["","60758077305","KETOROLAC","SOL 0.004","5","Select","Select",""],["","50111064801","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","24208045705","DICLOFENAC","SOL 0.1% OP","5","Select","Select",""],["","24208031510","POLYMYXIN","SOL TRIMETHP","10","Select","Select",""],["","","TRAZODONE","TAB 50MG","","Select","Select",""],["","","FLUCONAZOLE"," FLUCONAZOLE ","1","Select","Select",""],["","","VALACYCLOVIR"," VALACYCLOVIR ","30","Select","Select",""],["","","KETOCONAZOLE","SHA 0.02","","Select","Select",""],["","","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","","PAROXETINE"," PAROXETINE ","90","Select","Select",""],["","00065064705","TOBRADEX","SUS 0.3-0.1%","5","Select","Select",""],["","53489011802","DOXYCYCL","CAP 50MG","14","Select","Select",""],["","","METRONIDAZOL"," METRONIDAZOL ","14","Select","Select",""],["","24208029525","TOBRA\/DEXAME","SUS 0.3-0.1%","5","Select","Select",""],["","24208091055","ERYTHROMYCIN","OIN 5MG\/GM","4","Select","Select",""],["","","PREDNISONE"," PREDNISONE ","18","Select","Select",""],["","45802000403","HYDROCORT","CRE 0.025","28","Select","Select",""],["","69097012303","TOPIRAMATE","TAB 50MG","35","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","21","Select","Select",""],["","16571040250","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","00904530760","BANOPHEN","CAP 50MG","20","Select","Select",""],["","60505056000","OFLOXACIN","DRO 0.3% OP","5","Select","Select",""],["","65862084003","MOXIFLOXACIN","SOL HCL 0.5%","3","Select","Select",""],["","","VITAMIN"," VITAMIN ","4","Select","Select",""],["","","OSELTAMIVIR"," OSELTAMIVIR ","10","Select","Select",""],["","","SMZ\/TMP"," SMZ\/TMP ","14","Select","Select",""],["","","FEXOFENADINE"," FEXOFENADINE ","30","Select","Select",""],["","","TAMIFLU"," TAMIFLU ","10","Select","Select",""],["","","BENZONATATE"," BENZONATATE ","30","Select","Select",""],["","","CLOTRIM\/BETA"," CLOTRIM\/BETA ","45","Select","Select",""],["","","ALPRAZOLAM"," ALPRAZOLAM ","15","Select","Select",""],["","","SERTRALINE"," SERTRALINE ","60","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":""}]}]}