{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KHALIL DAHDAH","gend":0,"add":"16 BARCLAY ROAD","city":"NEWPORT NEWS","state":"VA","zip":"23606-9998","dob":"1964-05-02","age":"","mstatus":"","insh":"2224430*01","cliId":"","pno":"757\/773-7521","cno":"757\/773-7521","email":"","ename":"","eno":"","pphy":"PHYSICIAN, PRIMARY CARE (MISC)","ppno":"","pcpadd":"4417 CORPORATION LN","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":799999,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/773-7521","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":["F90.0","K21.9","E29.1","Z00.01","E78.00","Z13.89","Z12.5","J06.9","G47.33","U07.1","G47.30","F32.9","Z87.891","J45.909","Z79.82","Z79.899","Z79.51","Z79.890","R09.82","Z23.","Z68.28","R33.8","N52.9","R05.","E66.09","H33.321","H17.813","H04.123","Z00.00","F32.89","F51.01","H93.8X1","H92.01","R20.2","E66.3","J45.998","H01.02A","H01.02B","H04.121","H04.122","E55.9","Z68.27"],"date":["2021-08-05","2021-06-22","2021-08-05","2020-08-03","2021-08-05","2020-08-03","2021-08-05","2020-05-19","2021-05-21","2020-05-19","2020-05-19","2020-05-19","2020-05-19","2020-05-19","2020-05-19","2020-05-19","2020-05-19","2020-05-19","2020-05-19","2020-09-17","2020-09-17","2020-10-26","2020-10-26","2020-05-19","2020-04-20","2021-05-14","2021-05-14","2020-05-08","2021-08-05","2021-03-22","2021-08-05","2020-12-16","2020-12-16","2020-12-16","2020-12-16","2020-01-21","2021-05-14","2021-05-14","2021-05-14","2021-05-14","2021-08-05","2021-08-05"],"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":[["","68180078001","ZOLPIDEM","12.5MG","30","Select","Select",""],["","00456120130","LINZESS","145MCG","90","Select","Select",""],["","68180059306","DESVENLAFAX","100MG ER","90","Select","Select",""],["","59417010510","VYVANSE","50MG","-50","Select","Select",""],["","60505257908","ATORVASTATIN","20MG","90","Select","Select",""],["","60505083001","MOMETASONE","50MCG","51","Select","Select",""],["","64764017590","DEXILANT","60MG DR","90","Select","Select",""],["","08290309571","3ML","23GX1\"","7","Select","Select",""],["","50111043402","TRAZODONE","100MG","360","Select","Select",""],["","62756001540","TESTOST","200MG\/ML","12","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","68382089706","TADALAFIL","5MG","90","Select","Select",""],["","08290305180","FILL NEEDLE M","18GX1.5\"","7","Select","Select",""],["","00591544305","PREDNISONE","20MG","15","Select","Select",""],["","68180031902","BUPROPN","150MG XL","90","Select","Select",""],["","31722071130","SILDENAFIL","100MG","30","Select","Select",""],["","00093317431","ALBUTEROL","HFA","34","Select","Select",""],["","65862059805","TAMSULOSIN","0.4MG","90","Select","Select",""],["","65862007701","CIPROFLOXACN","500MG","20","Select","Select",""],["","00591264001","BUT\/APAP\/CAF","","-12","Select","Select",""],["","31722052530","FINASTERIDE","5MG","90","Select","Select",""],["","00065853302","CIPRODEX","0.3-0.1%","8","Select","Select",""],["","88888888887","DMR","","1","Select","Select",""],["","47335030888","ZOLPIDEM ","12.5MG","-90","Select","Select",""],["","68180059306","DESVENLAFAX ","100MG ER","90","Select","Select",""],["","60505083001","MOMETASONE ","50MCG","51","Select","Select",""],["","68180031902","BUPROPN ","150MG XL","90","Select","Select",""],["","60505257908","ATORVASTATIN ","20MG","90","Select","Select",""],["","50111043402","TRAZODONE ","100MG","360","Select","Select",""],["","59417010510","VYVANSE ","50MG","90","Select","Select",""],["","00456120130","LINZESS ","145MCG","90","Select","Select",""],["","68382089706","TADALAFIL ","5MG","90","Select","Select",""],["","64764017590","DEXILANT ","60MG DR","90","Select","Select",""],["","08290309571","3ML ","23GX1\"","7","Select","Select",""],["","08290305180","FILL  NEEDLE  M","18GX1.5\"","7","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00591264001","BUT\/APAP\/CAF ","","30","Select","Select",""],["","00065853302","CIPRODEX ","0.3-0.1%","8","Select","Select",""],["","62756001540","TESTOST ","200MG\/ML","12","Select","Select",""],["","00591544305","PREDNISONE ","20MG","15","Select","Select",""],["","88888888887","DMR ","","1","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","34","Select","Select",""],["","68382013201","TAMSULOSIN ","0.4MG","90","Select","Select",""],["","31722052530","FINASTERIDE ","5MG","90","Select","Select",""],["","31722071130","SILDENAFIL ","100MG","30","Select","Select",""],["","65862007701","CIPROFLOXACN ","500MG","-20","Select","Select",""],["","00173069500","ADVAIR ","100\/50","-180","Select","Select",""],["","00378932032","WIXELA ","100\/50","180","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":""}]}]}