{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NGOC   THI BICH LE","gend":1,"add":"2 MULLINS CT","city":"HAMPTON","state":"VA","zip":"23666-9998","dob":"1970-10-14","age":"","mstatus":"","insh":"2024157*02","cliId":"","pno":"757\/256-6264","cno":"757\/256-6264","email":"","ename":"","eno":"","pphy":"ELLIOTT, JOY DO","ppno":"757\/594-3800","pcpadd":"10510 JEFFERSON AVENUE STE A","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23601,"pcpcounty":"","pcpid":135802,"pcpname":"Riverside Brentwood Medical Center","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/256-6264","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":["K22.70","K29.40","B18.1","Z20.828","K64.8","K64.4","Z98.890","K64.9","K22.2","H04.123","J39.2","R94.5","K21.9","Z00.01","B07.8","F41.9","L81.4","L73.9","D48.5","R68.84","K64.3","Z12.31","Z12.11","K20.90","K12.0","L08.9","B35.1","Z01.419","R10.13","R53.83","R10.2","R23.3","K31.89","K44.9","N93.8"],"date":["2020-12-14","2020-12-16","2021-05-18","2021-04-29","2020-08-20","2020-12-02","2020-12-02","2020-12-08","2020-12-14","2021-01-18","2020-02-04","2021-05-27","2020-11-18","2021-10-05","2021-01-18","2021-05-10","2021-01-21","2021-01-21","2021-01-21","2020-02-04","2020-08-20","2021-10-18","2020-11-19","2020-12-16","2021-05-10","2021-05-18","2021-05-18","2021-10-07","2021-09-28","2021-09-21","2021-10-06","2021-10-05","2021-09-28","2021-09-28","2021-11-12"],"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":[["","10702025301","BUT\/APAP\/CAF","","-40","Select","Select",""],["","00781286810","OMEPRAZOLE","20MG DR","30","Select","Select",""],["","0","","","-30","Select","Select",""],["","00126028666","PREVIDENT","5000 PLS","51","Select","Select",""],["","00406051201","OXYCOD\/APAP","5-325MG","20","Select","Select",""],["","68462041820","LIDOCAINE","5%","-35","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","00713065540","TRIAMCINOLON","DEN 0.1%","5","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","65862037401","ESCITALOPRAM","10MG","30","Select","Select",""],["","00121086816","NYSTATIN","100000","150","Select","Select",""],["","00781286810","OMEPRAZOLE ","20MG DR","30","Select","Select",""],["","00126028666","PREVIDENT ","5000 PLS","51","Select","Select",""],["","10702025301","BUT\/APAP\/CAF ","","-40","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","68462041820","LIDOCAINE ","5%","35","Select","Select",""],["","00406051201","OXYCOD\/APAP ","5-325MG","20","Select","Select",""],["","65862037401","ESCITALOPRAM ","10MG","30","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","473","Select","Select",""],["","00713065540","TRIAMCINOLON ","DEN 0.1%","5","Select","Select",""],["","59267100002","PFIZER ","COVID-19","0","Select","Select",""],["","00121086816","NYSTATIN ","100000","150","Select","Select",""],["","65862056090","PANTOPRAZOLE","40MG","90","Select","Select",""],["","69097081307","GABAPENTIN","100MG","60","Select","Select",""],["","00591079401","DICYCLOMINE ","CAP 10MG","30","Select","Select",""],["","59746017206","PREDNISONE ","TAB 5MG","30","Select","Select",""],["","65862086001","FAMOTIDINE ","TAB 40MG","-30","Select","Select",""],["","65862056090","PANTOPRAZOLE ","TAB 40MG","90","Select","Select",""],["","69097081307","GABAPENTIN ","CAP 100MG","60","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50\/0.5ML","1","Select","Select",""],["","58160088752","FLUARIX ","INJ 2021-22","0","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":""}]}]}