{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" CHRISTIAN RASHAD MCCAIN","gend":0,"add":"153 SEA ST","city":"VIRGINIA BEACH","state":"VA","zip":"23451-9998","dob":"1991-12-01","age":"","mstatus":"","insh":"1861211*01","cliId":"","pno":"757\/381-3509","cno":"757\/381-3509, 757\/201-5623, ","email":"","ename":"","eno":"","pphy":"SAN-MARINA, ANDREI MD","ppno":"757\/425-3610","pcpadd":"STE A 940 GENERAL BOOTH BLV","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23451-9998","pcpcounty":"","pcpid":153229,"pcpname":"","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":["K29.00","Z21.","Z79.899","Z88.5","R11.2","M54.6","M94.0","R49.0","R07.1","B20.","R51.","R68.83","Z13.89","Z86.2","Z11.3","Z00.00","Z13.220","M79.18","M54.5","M46.1","K04.01","Z88.6","K08.89","R19.7","R52.","M62.89","Z13.21","G58.8","R79.89","H00.014","L30.9"],"date":["2020-03-23","2020-05-31","2020-03-23","2020-05-31","2020-08-06","2020-09-02","2020-10-28","2021-03-11","2020-03-27","2021-06-10","2020-08-06","2020-08-06","2020-11-12","2020-11-12","2021-06-10","2021-06-10","2020-09-10","2020-10-28","2020-10-28","2020-10-28","2020-05-31","2020-05-31","2020-05-31","2020-08-06","2020-08-06","2020-11-25","2021-02-18","2021-02-18","2021-06-10","2020-03-09","2020-03-09"],"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":[["","61958200201","DESCOVY","200\/25","-30","Select","Select",""],["","49702022813","TIVICAY","50MG","-30","Select","Select",""],["","55111015930","OMEPRAZOLE","40MG","30","Select","Select",""],["","00781261305","AMOXICILLIN","500MG","22","Select","Select",""],["","24208091055","ERYTHROMYCIN","OP","4","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","-12","Select","Select",""],["","61958250101","BIKTARVY","","-30","Select","Select",""],["","65162027250","SMZ\/TMP","800-160","14","Select","Select",""],["","54092019112","PENTASA","500MG CR","-28","Select","Select",""],["","43598029390","PREGABALIN","75MG","60","Select","Select",""],["","53451010101","HORIZANT","600MG ER","60","Select","Select",""],["","62175061846","PANTOPRAZOLE","20MG","30","Select","Select",""],["","69452015120","VITAMIN","50000UNT","12","Select","Select",""],["","00093117410","PENICILLN","500MG","28","Select","Select",""],["","60505384901","CELECOXIB","200MG","-30","Select","Select",""],["","42571016242","AMOX\/K","875-125","20","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","00093221001","SUCRALFATE","1GM","100","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":""}]}]}