{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TUAN   MINH VU","gend":0,"add":"5133 CRYSTAL POINT DR","city":"VIRGINIA BEACH","state":"VA","zip":"23455-9998","dob":"2002-07-12","age":"","mstatus":"","insh":"2349544*03","cliId":"","pno":"845\/418-7859","cno":"845\/418-7859","email":"","ename":"","eno":"","pphy":"BORRERO, CHARIN M PA","ppno":"757\/318-6900","pcpadd":"2017 PLEASURE HOUSE RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23455,"pcpcounty":"","pcpid":300194,"pcpname":"SMG - Sentara Family Medicine Physicians - Thoroughgood","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"845\/418-7859","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":["H93.13","H92.09","Z00.01","G25.0","H93.11","J31.0","H69.83","K29.70","K21.9","S01.81XA","R42.","H53.8","S01.81XD","Z48.02","V89.2XXA","Y92.410","Y93.89"],"date":["2021-04-13","2021-03-20","2021-03-26","2021-05-03","2021-05-03","2021-05-25","2021-05-25","2021-07-20","2021-07-20","2021-09-10","2021-09-10","2021-09-10","2021-09-15","2021-09-15","2021-09-10","2021-09-10","2021-09-10"],"priorHcc":["","","","","","","","","","","","",null,null,null,null,null]}},{"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":[["","45802065078","LORATADINE","10MG","30","Select","Select",""],["","59779043262","NASAL","30MG","24","Select","Select",""],["","24208063562","NEO\/POLY\/HC","1% OTIC","10","Select","Select",""],["","65862050220","AMOX\/K","500-125","20","Select","Select",""],["","45802043262","PSEUDOEPHEDR","30MG","24","Select","Select",""],["","50742061510","METOPROL","25MG ER","30","Select","Select",""],["","65862050220","AMOX\/K ","500-125","20","Select","Select",""],["","45802043262","PSEUDOEPHEDR ","30MG","24","Select","Select",""],["","50742061510","METOPROL ","25MG ER","30","Select","Select",""],["","59779043262","NASAL ","30MG","24","Select","Select",""],["","45802065078","LORATADINE ","10MG","30","Select","Select",""],["","59267100003","PFIZER ","COVID-19","0","Select","Select",""],["","65862086001","FAMOTIDINE ","40MG","30","Select","Select",""],["","24208063562","NEO\/POLY\/HC ","1% OTIC","10","Select","Select",""],["","59651000305","OMEPRAZOLE ","40MG","30","Select","Select",""],["","59651000305","OMEPRAZOLE","40MG","30","Select","Select",""],["","59267100003","PFIZER","COVID-19","0","Select","Select",""],["","65862086001","FAMOTIDINE","40MG","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":""}]}]}