{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" OSCAR LEON","gend":0,"add":"412 MIDDLE ST APT E","city":"PORTSMOUTH","state":"VA","zip":"23704-9998","dob":"1969-05-13","age":"","mstatus":"","insh":"1713075*01","cliId":"","pno":"757\/971-8419","cno":"757\/971-8419, 252\/207-4648, ","email":"","ename":"","eno":"","pphy":"HIGDON, PATRICK MD","ppno":"757\/889-2006","pcpadd":"110 KINGSLEY LANE STE 309","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23505-9998","pcpcounty":"","pcpid":119354,"pcpname":"DEPAUL HOSPITALIST GROUP","plan":"OHP - OPTIMA","program":"ACA","lob":"Individual","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":["R14.0","R10.9","R19.4","K57.30","B20.","F32.9","M54.5","G89.29","J45.909","E29.1","R51.","M48.061","M43.16","M43.17","M41.86","M41.87","M51.16","M48.07","M54.16","Z23.","R79.89","R74.8","R76.8","R06.02","M46.1","M47.816","M51.26","M79.604","R51.9","Z79.891","K29.50","M54.41","J06.9","B97.89","M19.90","Z79.899","Z82.49","R50.9","F45.42","H10.13","Z21.","R06.7","J02.9","R06.00","M51.36","R63.5"],"date":["2021-03-29","2020-12-03","2020-12-03","2020-12-03","2021-03-29","2021-03-29","2021-03-29","2021-05-21","2021-05-21","2020-12-10","2020-09-24","2020-12-31","2020-12-31","2020-12-31","2020-12-31","2020-12-31","2020-12-31","2020-12-31","2020-12-31","2020-09-04","2020-12-10","2020-09-24","2020-09-24","2020-10-08","2021-01-21","2020-12-31","2020-12-31","2021-03-05","2020-12-10","2020-12-18","2020-12-03","2021-04-01","2020-02-23","2020-02-23","2020-02-23","2021-05-21","2020-02-23","2020-02-23","2020-12-18","2021-05-21","2021-05-21","2021-05-21","2020-08-22","2020-10-08","2021-03-10","2020-11-05"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","15584010101","ATRIPLA","","30","Select","Select",""],["","00093742698","MONTELUKAST","10MG","30","Select","Select",""],["","50111043401","TRAZODONE","100MG","30","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","48","Select","Select",""],["","31722050430","EFAVIRENZ","600MG","-30","Select","Select",""],["","61958200201","DESCOVY","200\/25","-30","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","00591565810","CYCLOBENZAPR","10MG","10","Select","Select",""],["","68180016006","AZITHROMYCIN","250MG","4","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","00054001829","PREDNISONE","20MG","23","Select","Select",""],["","69097094312","GABAPENTIN","300MG","90","Select","Select",""],["","00093005805","TRAMADOL","50MG","20","Select","Select",""],["","00143975001","TESTOST","200MG\/ML","5","Select","Select",""],["","67877057505","BENZONATATE","200MG","15","Select","Select",""],["","65649040001","PLENVU","","3","Select","Select",""],["","00603188016","LIDOCAINE","5%","30","Select","Select",""],["","71930005552","APAP\/CODEINE","300-30MG","90","Select","Select",""],["","08290309589","3ML","23GX1.5\"","-4","Select","Select",""],["","65162083366","DICLOFENAC","1%","100","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","20","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","88888888887","DMR","","1","Select","Select",""],["","58914060120","PYLERA","","120","Select","Select",""],["","31722070090","LOSARTAN","25MG","90","Select","Select",""],["","00093310905","AMOXICILLIN","500MG","40","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","3","Select","Select",""],["","00093768432","OLOPATADINE","0.20%","2","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","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","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":""}]}]}