{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PHI   T NGUYEN","gend":1,"add":"2100 BAINBRIDGE BLVD APT 3","city":"CHESAPEAKE","state":"VA","zip":"23324-9998","dob":"1954-01-01","age":"","mstatus":"","insh":"900035527*01","cliId":"1T42TW1EF07","pno":"757\/230-1552","cno":"757\/230-1552","email":"","ename":"","eno":"","pphy":"LE, DAU T MD","ppno":"757\/671-8746","pcpadd":"SUITE 104 5444 VIRGINIA BEACH BLVD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":671359,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/363-8626","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R42.","R11.2","J84.10","I27.0","D64.9","Z86.69","R11.10","L13.9","E04.2","H16.223","I82.C11","J47.1","J02.9","R04.2","J84.9","R06.2","K21.9","Z79.82","Z79.899","Z88.0","I44.4","R31.0","R31.9","E07.9","I82.C12","I82.290","Z88.1","Z79.1","R53.1","R53.83","R52.","E87.1","E86.0","R11.0","Z20.822","R09.89","R91.8","A41.9","J98.11","R50.9","J18.9","E43.","R53.81","I50.9","I42.9","I50.22","Z86.19","J98.4","R93.1","N95.0","R93.89","D25.9","D50.9","N93.9","J13.","I51.81","Z68.1","Z86.11","D69.6","M35.3","Z79.52","Z88.6","R19.7","B34.9","I50.21","R65.21","J47.0","E87.6","E88.81","R62.7","J18.1","B95.3","J47.9","I31.3","R91.1","R06.00","R68.83","Z86.14","R77.8","M79.10","R78.81","R10.2","N85.2","Z01.810","N39.0","R73.09","A40.3","K72.00","E46.","E50.9","K29.71","R64.","Z01.419","Z12.11","N95.2","N84.0","N32.9","N32.89","R79.89","N30.01","S40.861A","Z01.812","R94.31","E78.5","I10.","J44.1","D50.8","Z09.","Z87.01","N30.30","N90.5","Z87.440","Z79.890"],"date":["2020-10-24","2020-10-24","2021-06-20","2020-10-24","2021-08-11","2020-10-24","2020-10-24","2020-10-24","2020-10-24","2020-10-21","2020-10-23","2021-03-25","2021-03-25","2021-03-25","2021-10-05","2021-03-25","2021-03-25","2021-06-12","2021-08-11","2021-06-20","2020-10-23","2019-07-02","2021-08-11","2021-06-12","2020-10-23","2020-10-23","2020-10-23","2021-08-11","2021-06-12","2021-06-12","2021-06-20","2021-06-20","2021-06-10","2021-06-12","2021-06-10","2021-06-10","2021-06-20","2021-06-20","2021-06-12","2021-06-12","2021-06-16","2021-06-20","2021-06-16","2021-08-11","2021-07-07","2021-10-01","2021-06-27","2021-06-12","2021-06-16","2021-08-11","2021-07-07","2021-08-06","2021-10-05","2021-07-07","2021-06-20","2021-06-21","2021-06-20","2021-08-11","2021-06-20","2021-06-20","2021-08-11","2021-08-11","2021-06-20","2021-06-10","2021-06-16","2021-06-16","2021-06-12","2021-06-12","2021-06-12","2021-10-01","2021-06-16","2021-06-26","2021-06-26","2021-06-20","2021-06-26","2021-06-20","2021-06-20","2021-06-12","2021-06-20","2021-06-26","2021-06-26","2021-08-06","2021-08-06","2021-08-06","2021-08-09","2021-08-09","2021-06-16","2021-06-16","2021-06-16","2021-07-08","2021-07-08","2021-07-08","2021-07-28","2021-07-28","2021-08-11","2021-08-11","2021-08-11","2021-08-11","2021-06-20","2021-07-19","2021-07-19","2021-08-06","2021-08-06","2021-08-11","2021-10-05","2021-10-01","2021-10-01","2021-10-05","2021-10-05","2021-08-11","2021-08-11","2021-08-11","2021-08-11"],"priorHcc":["","","","","","","","","","","","","","",null,"","","",null,"","","","","","","","",null,"","","","","","","","","","","","","","","","","",null,"","","","","","",null,"","","","",null,"","",null,null,"","","","","","","",null,"","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","",null,null,null,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":[["","16571066101","MECLIZINE","TAB 25MG","15","Select","Select",""],["","363056314","ASPIRIN LOW","TAB 81MG EC","30","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","7","Select","Select",""],["","527131530","RIFAMPIN","CAP 300MG","30","Select","Select",""],["","42806031250","DOXYCYCL HYC","TAB 100MG","-14","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","12","Select","Select",""],["","50268085815","VITAMIN B6","TAB 50MG","30","Select","Select",""],["","67253066010","PYRAZINAMIDE","TAB 500MG","30","Select","Select",""],["","65862064230","AZITHROMYCIN","TAB 500MG","3","Select","Select",""],["","42806031250","DOXYCYCLINE HYCLATE","","14","Select","Select",""],["","76204020025","ALBUTEROL SULFATE","","150","Select","Select",""],["","68462010530","ONDANSETRON HYDROCHLORIDE ","","12","Select","Select",""],["","59746012106","MECLIZINE HCL ","","15","Select","Select",""],["","16571066101","MECLIZINE HYDROCHLORIDE","","-15","Select","Select",""],["","363056314","ASPIRIN LOW DOSE","","30","Select","Select",""],["","69097014260","ALBUTEROL SULFATE HFA","","7","Select","Select",""],["","59746012106","MECLIZINE HCL","","-15","Select","Select",""],["","68462010530","ONDANSETRON HYDROCHLORIDE","","12","Select","Select",""],["","68001024617","ONDANSETRON ODT","","20","Select","Select",""],["","65862053820","LEVOFLOXACIN","","10","Select","Select",""],["","00904759180","FEROSUL","","100","Select","Select",""],["","69452014320","BENZONATATE","","30","Select","Select",""],["","59746017206","PREDNISONE","","21","Select","Select",""],["","49884090738","MEGESTROL ACETATE","","300","Select","Select",""],["","68001015303","CARVEDILOL","","60","Select","Select",""],["","65162027210","SULFAMETHOXAZOLE\/TRIMETHOPRIM DS","","14","Select","Select",""],["","65162036110","FOLIC ACID","","100","Select","Select",""],["","69452015120","VITAMIN D","","4","Select","Select",""],["","00093314505","CEPHALEXIN","250MG","21","Select","Select",""],["","00065806401","GENTEAL SEVERE TEARS","0.30%","10","Select","Select",""],["","51672128202","TRIAMCINOLONE ACETONIDE","0.10%","30","Select","Select",""],["","65862085901","FAMOTIDINE","20MG","60","Select","Select",""],["","62175011843","OMEPRAZOLE","20MG","30","Select","Select",""],["","24208091055","ERYTHROMYCIN","5MG\/GM","4","Select","Select",""],["","51293081001","PHENAZOPYRIDINE HYDROCHLORIDE","100MG","9","Select","Select",""],["","69367016304","PHENAZOPYRIDINE HCL","200MG","15","Select","Select",""],["","00143992801","CIPROFLOXACIN HYDROCHLORIDE","500MG","10","Select","Select",""],["","58602070584","ACID REDUCER","10MG","90","Select","Select",""],["","16571066101","MECLIZINE HYDROCHLORIDE                                               ","TAB 25MG","15","Select","Select",""],["","59746012106","MECLIZINE HCL                                                         ","TAB 25MG","-15","Select","Select",""],["","00363056314","ASPIRIN LOW DOSE                                                      ","TAB 81MG EC","30","Select","Select",""],["","68462010530","ONDANSETRON HYDROCHLORIDE                                             ","TAB 4MG","12","Select","Select",""],["","65862064230","AZITHROMYCIN                                                          ","TAB 500MG","-3","Select","Select",""],["","00904759180","FEROSUL                                                               ","TAB 325MG","100","Select","Select",""],["","69452014320","BENZONATATE                                                           ","CAP 100MG","30","Select","Select",""],["","59746017206","PREDNISONE                                                            ","TAB 5MG","21","Select","Select",""],["","69367016304","PHENAZOPYRIDINE HCL                                                   ","TAB 200MG","15","Select","Select",""],["","62175011843","OMEPRAZOLE                                                            ","CAP 20MG","-30","Select","Select",""],["","65862053820","LEVOFLOXACIN                                                          ","TAB 750MG","10","Select","Select",""],["","68001015303","CARVEDILOL                                                            ","TAB 3.125MG","60","Select","Select",""],["","00143992801","CIPROFLOXACIN HYDROCHLORIDE                                           ","TAB 500MG","10","Select","Select",""],["","65862085901","FAMOTIDINE                                                            ","TAB 20MG","60","Select","Select",""],["","00065806401","GENTEAL SEVERE TEARS                                                  ","GEL 0.003","10","Select","Select",""],["","68001024617","ONDANSETRON ODT                                                       ","TAB 4MG ODT","20","Select","Select",""],["","69097014260","ALBUTEROL SULFATE HFA                                                 ","AER HFA","7","Select","Select",""],["","65162027210","SULFAMETHOXAZOLE\/TRIMETHOPRIM DS                                      ","TAB 800-160","14","Select","Select",""],["","69452015120","VITAMIN D                                                             ","CAP 50000UNT","4","Select","Select",""],["","49884090738","MEGESTROL ACETATE                                                     ","SUS 40MG\/ML","300","Select","Select",""],["","51672128202","TRIAMCINOLONE ACETONIDE                                               ","CRE 0.001","30","Select","Select",""],["","00093314505","CEPHALEXIN                                                            ","CAP 250MG","-21","Select","Select",""],["","24208091055","ERYTHROMYCIN                                                          ","OIN 5MG\/GM","4","Select","Select",""],["","60432060416","PROMETHAZINE\/DEXTROMETHORPHAN                                         ","SYP DM","150","Select","Select",""],["","58602070584","ACID REDUCER                                                          ","TAB 10MG","90","Select","Select",""],["","65162036110","FOLIC ACID                                                            ","TAB 1MG","100","Select","Select",""],["","51293081001","PHENAZOPYRIDINE HYDROCHLORIDE                                         ","TAB 100MG","9","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":""}]}]}