{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JIHAD HAMMAD","gend":1,"add":"1642 PLANTATION WOODS WAY","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"1969-11-26","age":"","mstatus":"","insh":"2360139*01","cliId":"","pno":"757\/535-7666","cno":"757\/535-7666","email":"","ename":"","eno":"","pphy":"MANDELL JR, M STEPHEN MD","ppno":"804\/633-5840","pcpadd":"121 COURTHOUSE LN","pcpcity":"BOWLING GREEN","pcpstate":"VA","pcpzip":22427,"pcpcounty":"","pcpid":195552,"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":["G56.03","M54.12","G47.33","Z01.419","Z12.39","Z12.72","Z90.710","N95.2","B00.9","Z51.11","C83.30","K12.30","G56.23","K59.00","K21.9","M54.2","R11.0","T45.1X5A","Z79.899","Z87.891","M54.5","C83.39","G56.01","M47.812","R87.615","M79.643","D64.81","E87.6","G56.22","M25.531","R20.2","M79.641","Z85.72","M48.02","G95.9","M50.30","K12.31","M79.642","R93.7","B37.3","M54.16","G56.21","R53.83","C85.10","B00.1","E55.9","Z86.19","M89.8X9","Z92.21","E04.1","T78.40XA","E04.2","L28.0","L81.1","Z71.9","J30.1","D34.","Z88.0","Z88.1","Z79.1","J98.59","R91.1","G56.02","H81.399","R06.83","J34.3","H69.83","R42.","M25.552","G47.61","C79.51","K57.30"],"date":["2021-05-18","2021-04-08","2021-11-15","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-01-29","2021-09-13","2021-01-26","2021-01-26","2021-01-26","2021-11-11","2021-05-20","2021-01-26","2021-01-26","2021-11-05","2021-01-26","2021-05-20","2021-11-22","2021-06-24","2021-01-26","2021-04-16","2021-01-08","2021-01-08","2021-01-08","2021-01-15","2021-01-07","2021-01-07","2021-01-07","2021-01-07","2021-05-18","2021-01-07","2021-01-07","2021-01-05","2021-01-05","2021-01-29","2021-01-22","2021-04-08","2021-04-08","2021-04-16","2021-11-11","2021-11-11","2021-11-11","2021-05-18","2021-06-29","2021-09-13","2021-11-05","2021-09-29","2021-10-25","2021-09-21","2021-09-21","2021-09-21","2021-11-09","2021-10-12","2021-10-12","2021-10-12","2021-10-12","2021-09-13","2021-09-13","2021-09-29","2021-10-25","2021-10-25","2021-10-25","2021-10-25","2021-10-05","2021-11-05","2021-11-15","2021-11-22","2021-11-22"],"priorHcc":["","",null,"","","","","","","","","","","",null,"","","",null,"","",null,"","","","","","","","","","","","","","","","","","","","","",null,null,null,"","",null,null,null,null,"","","",null,null,null,null,null,null,null,null,null,null,null,null,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":[["","00378427677","VALACYCLOVIR","1GM","90","Select","Select",""],["","69452015120","VITAMIN","50000UNT","-4","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","1","Select","Select",""],["","00054449810","LEUCOVOR","15MG","6","Select","Select",""],["","69097067805","PREGABALIN","50MG","60","Select","Select",""],["","0","","","400","Select","Select",""],["","64380080707","IBUPROFEN","800MG","90","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","-12","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","00054449810","LEUCOVOR ","15MG","6","Select","Select",""],["","65862044930","VALACYCLOVIR ","1GM","14","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","4","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","90","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","-12","Select","Select",""],["","69097067805","PREGABALIN ","50MG","60","Select","Select",""],["","57237000511","FLUCONAZOLE ","150MG","1","Select","Select",""],["","00299595030","TRI-LUMA","","30","Select","Select",""],["","68462015713","ONDANSETRON","4MG ODT","-30","Select","Select",""],["","65162006205","SUCRALFATE","1GM\/10ML","1260","Select","Select",""],["","00187000545","ALTRENO","0.05%","45","Select","Select",""],["","00299595030","TRI-LUMA ","CRE ","30","Select","Select",""],["","68462015713","ONDANSETRON ","TAB 4MG ODT","-30","Select","Select",""],["","65162006205","SUCRALFATE ","SUS 1GM\/10ML","1260","Select","Select",""],["","00187000545","ALTRENO ","LOT 0.0005","45","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","48","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":""}]}]}