{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RASHID   OMAR ISLAM","gend":0,"add":"864 WESTMINSTER LN","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1988-08-12","age":"","mstatus":"","insh":"1753500*01","cliId":"","pno":"757\/575-9054","cno":"757\/575-9054","email":"","ename":"","eno":"","pphy":"WEST, DAVID J MD","ppno":"757\/547-9286","pcpadd":"113 GAINSBOROUGH SQ STE 300","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":210342,"pcpname":"","plan":"OHP","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":["F29.","N39.0","F60.9","F31.9","M54.5","E55.9","E78.5","H93.19","H66.92","F43.20","F33.1","F41.9","F90.9","T16.2XXA","F17.299","F22.","D72.829","R79.89","Z11.59","Z87.891","Z04.6","F23.","Z11.3","R41.840","Z20.828","F39."],"date":["2020-05-31","2020-05-31","2020-05-31","2020-05-31","2020-05-31","2020-07-09","2020-07-09","2020-05-31","2020-05-31","2021-07-21","2021-06-29","2021-07-13","2021-07-13","2020-06-19","2020-06-19","2021-07-13","2020-05-30","2020-05-30","2020-05-30","2020-05-30","2020-05-30","2020-06-01","2020-07-09","2020-08-17","2021-03-23","2021-07-13"],"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":[["","35573041830","ATOMOXETINE","40MG","60","Select","Select",""],["","00832153011","HALOPERIDOL","2MG","28","Select","Select",""],["","69238111801","BUSPIRONE","15MG","28","Select","Select",""],["","00093506101","HYDROXYZ","25MG","90","Select","Select",""],["","88888888887","DMR","","1","Select","Select",""],["","24208063562","NEO\/POLY\/HC","1% OTIC","10","Select","Select",""],["","69097083412","SERTRALINE","50MG","30","Select","Select",""],["","00185086401","AMPHET\/DEXTR","30MG","60","Select","Select",""],["","70377002713","ATORVASTATIN","10MG","90","Select","Select",""],["","43598075360","BUPROPION","200MG SR","14","Select","Select",""],["","00172392670","DIAZEPAM","5MG","60","Select","Select",""],["","51672129303","CLOBETASOL","0.05%","-50","Select","Select",""],["","13107001401","GLYCOPYRROL","1MG","30","Select","Select",""],["","27241005203","ARIPIPRAZOLE","5MG","30","Select","Select",""],["","45802014167","CICLOPIROX","8%","7","Select","Select",""],["","00069047103","CHANTIX","0.5& 1MG","53","Select","Select",""],["","00781185220","AMOX\/K","875-125","8","Select","Select",""],["","27241006803","SILDENAFIL","50MG","5","Select","Select",""],["","45802046564","KETOCONAZOLE","2%","120","Select","Select",""],["","00168000480","TRIAMCINOLON","0.10%","80","Select","Select",""],["","65862019399","FLUOXETINE","20MG","30","Select","Select",""],["","00832153011","HALOPERIDOL ","2MG","-28","Select","Select",""],["","00781185220","AMOX\/K ","875-125","8","Select","Select",""],["","43598075360","BUPROPION ","200MG SR","14","Select","Select",""],["","69238111801","BUSPIRONE ","15MG","28","Select","Select",""],["","24208063562","NEO\/POLY\/HC ","1% OTIC","10","Select","Select",""],["","00069047103","CHANTIX ","0.5& 1MG","-53","Select","Select",""],["","35573041830","ATOMOXETINE ","40MG","60","Select","Select",""],["","00093506101","HYDROXYZ ","25MG","90","Select","Select",""],["","88888888887","DMR ","","1","Select","Select",""],["","45802046564","KETOCONAZOLE ","2%","120","Select","Select",""],["","00168000480","TRIAMCINOLON ","0.10%","80","Select","Select",""],["","13107001401","GLYCOPYRROL ","1MG","30","Select","Select",""],["","68382095601","AMPHET\/DEXTR ","30MG","60","Select","Select",""],["","00172392670","DIAZEPAM ","5MG","60","Select","Select",""],["","65862019399","FLUOXETINE ","20MG","30","Select","Select",""],["","70377002713","ATORVASTATIN ","10MG","90","Select","Select",""],["","69097083412","SERTRALINE ","50MG","30","Select","Select",""],["","45802014167","CICLOPIROX ","8%","7","Select","Select",""],["","51672129303","CLOBETASOL ","0.05%","50","Select","Select",""],["","27241006803","SILDENAFIL ","50MG","5","Select","Select",""],["","27241005203","ARIPIPRAZOLE ","5MG","30","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","",""],["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":""}]}]}