{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TUAN   M NGUYEN","gend":0,"add":"1305   WARFIELD ROAD                                        ","city":"HENRICO                       ","state":"VA","zip":"23229-5407","dob":"1983-11-11","age":"","mstatus":"","insh":10050357,"cliId":"","pno":8048685059,"cno":8048685059,"email":"","ename":"","eno":"","pphy":"BUSH, JAMES A","ppno":"","pcpadd":"815 W POYTHRESS ST","pcpcity":"HOPEWELL                      ","pcpstate":"VA","pcpzip":238602532,"pcpcounty":"","pcpid":"P0118404","pcpname":"HOPEWELL MEDICAL CENTER","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"1305   WARFIELD ROAD                                        ","madd2":"                                                            ","madd3":"","mcity":"HENRICO                       ","mstate":"VA","mzip":"23229-5407","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["ASIAN\/PACIFIC"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G47.33","I10","Z28.21","F41.9","M1A.9XX0","N52.9","H33.22","J30.1","K21.9","Z71.9","E78.5","Z87.39","H33.8","H26.223","J30.9","J01.00","F32.2","F41.1","F33.1","F43.10","F32.9","Z03.89","F31.9","F31.62","H27.112","R53.1","H53.8","Z04.9","H33.21","T85.22XA","H35.712","Q11.1","H27.132","Z96.1","E66.9"],"date":["2021-09-21","2021-11-24","2020-01-16","2021-09-21","2019-06-06","2019-06-06","2021-03-11","2019-06-06","2021-09-21","2020-01-16","2021-11-24","2020-01-30","2020-01-30","2020-01-30","2021-03-31","2020-01-30","2020-04-27","2021-10-06","2020-07-27","2020-06-24","2020-10-22","2021-10-06","2021-10-06","2021-03-31","2021-08-31","2021-03-09","2021-03-09","2021-03-09","2021-03-11","2021-09-13","2021-03-11","2021-03-11","2021-03-16","2021-11-09","2021-09-21"],"priorHcc":["",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":[["","10370010250","BUPROPN","300MG XL","30","Select","Select",""],["","69097084805","ESCITALOPRAM","10MG","30","Select","Select",""],["","68180098003","LISINOPRIL","10MG","30","Select","Select",""],["","70377002711","ATORVASTATIN","10MG","30","Select","Select",""],["","68180072103","AMLODIPINE","10MG","90","Select","Select",""],["","00093816301","QUETIAPINE","200MG","30","Select","Select",""],["","62175061743","PANTOPRAZOLE","40MG","90","Select","Select",""],["","59779045839","CVS","10MG","30","Select","Select",""],["","45802091987","CETIRIZINE","10MG","30","Select","Select",""],["","60505056000","OFLOXACIN","0.3% OP","5","Select","Select",""],["","60758011910","PREDNISOLONE","1% OP","10","Select","Select",""],["","24208072002","DEXAMETH","0.1% OP","5","Select","Select",""],["","50111056001","TRAZODONE","50MG","60","Select","Select",""],["","65862059501","DIVALPROEX","500MG ER","30","Select","Select",""],["","65862001501","AMOXICILLIN","875MG","20","Select","Select",""],["","23155019101","BUPROPION","75MG","60","Select","Select",""],["","10370010250","BUPROPN ","TAB 300MG XL","30","Select","Select",""],["","69097084805","ESCITALOPRAM ","TAB 10MG","30","Select","Select",""],["","65862049301","QUETIAPINE ","TAB 200MG","30","Select","Select",""],["","68180098003","LISINOPRIL ","TAB 10MG","30","Select","Select",""],["","70377002711","ATORVASTATIN ","TAB 10MG","30","Select","Select",""],["","68180072103","AMLODIPINE ","TAB 10MG","90","Select","Select",""],["","62175061743","PANTOPRAZOLE ","TAB 40MG","90","Select","Select",""],["","59779045839","CVS ","TAB 10MG","30","Select","Select",""],["","24208072002","DEXAMETH ","SOL 0.1% OP","5","Select","Select",""],["","45802091987","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","60505056000","OFLOXACIN ","DRO 0.3% OP","5","Select","Select",""],["","60758011910","PREDNISOLONE ","SUS 1% OP","10","Select","Select",""],["","50111056001","TRAZODONE ","TAB 50MG","60","Select","Select",""],["","65862059501","DIVALPROEX ","TAB 500MG ER","30","Select","Select",""],["","65862001501","AMOXICILLIN ","TAB 875MG","20","Select","Select",""],["","23155019101","BUPROPION ","TAB 75MG","60","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","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}