{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JUANITO   FLORES ANGELES","gend":0,"add":"1201 TAMARA CT","city":"VIRGINIA BEACH","state":"VA","zip":"23453-9998","dob":"1979-11-20","age":"","mstatus":"","insh":"8317895*01","cliId":"","pno":"757\/692-2000","cno":"757\/692-2000","email":"","ename":"","eno":"","pphy":"DESAI, GAUTAM D MD","ppno":"757\/471-6977","pcpadd":"2020 S INDEPENDENCE 3","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23453,"pcpcounty":"","pcpid":310059,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"622-7079","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/471-5300","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z48.21","Z94.1","I27.20","I12.9","Z79.899","I10.","N18.3","N18.32","E11.3512","E11.3511","Z98.890","H25.12","D84.821","E78.5","Z51.81","E11.69","S90.421A","D84.9","S90.423A","Z94.0","E11.319","E11.40","N18.30","Z87.891","Z88.8","Z88.6","I15.1","N28.89","M81.0","Z94.9","Z79.52","I37.1","I50.33","E78.2","L97.519","E78.00","E66.9","E66.3","R60.0","E11.9","T86.21","E11.22","D63.1","I08.8","D69.6","R80.9","K21.9","H53.50","Z86.79","Z79.4","Z92.25","T86.91","Z94.89","Z01.812","I13.0","Z82.49","E87.70","I11.0","E11.621","L97.511","N18.9","Z79.84","T86.290","N18.6","I15.9","Z99.2","Z00.00","T86.22","N17.9","I25.811","I50.43","Z86.74","E87.0","E11.8","E11.42","I50.30","B07.0","E11.3553","H25.11","N18.4","I36.1","I50.42","N28.1","I07.1","I13.10","E79.0"],"date":["2021-06-07","2021-09-27","2021-09-02","2021-09-15","2021-09-14","2021-09-02","2020-04-15","2021-04-01","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-09-02","2021-09-22","2021-09-02","2021-08-03","2021-05-15","2021-05-15","2021-05-15","2021-05-15","2021-09-14","2021-05-15","2021-09-27","2021-05-15","2021-05-15","2021-05-15","2021-06-07","2020-05-13","2020-06-29","2020-06-29","2021-09-14","2021-09-02","2021-01-29","2021-04-01","2020-09-08","2021-08-03","2021-08-03","2021-09-27","2021-09-27","2021-09-27","2021-04-15","2021-09-15","2021-01-29","2021-06-02","2020-03-18","2020-10-12","2021-09-14","2021-06-04","2021-06-04","2021-09-14","2020-02-19","2020-02-19","2021-09-02","2020-06-20","2020-11-10","2020-11-10","2021-01-27","2021-01-27","2021-06-30","2021-06-30","2020-03-18","2020-03-18","2020-06-23","2020-06-23","2020-06-23","2021-01-29","2020-08-10","2021-09-15","2021-01-26","2021-01-26","2021-01-26","2021-01-26","2021-01-29","2021-06-30","2021-06-30","2020-01-15","2020-08-24","2020-10-01","2021-06-17","2021-09-02","2021-09-02","2021-09-14","2021-09-17","2021-09-02","2021-09-27","2021-09-27"],"priorHcc":["",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":[["","00093551798","SILDENAFIL","20MG","-90","Select","Select",""],["","00378064010","PREDNISONE","5MG","30","Select","Select",""],["","70377002711","ATORVASTATIN","10MG","30","Select","Select",""],["","00002751001","HUMALOG","100\/ML","30","Select","Select",""],["","00054016625","MYCOPHENOLAT","500MG","-120","Select","Select",""],["","00781210201","TACROLIMUS","0.5MG","180","Select","Select",""],["","67877019905","AMLODIPINE","10MG","30","Select","Select",""],["","23155000201","HYDRALAZINE","25MG","270","Select","Select",""],["","00002803101","GLUCAGON","1MG","2","Select","Select",""],["","00185012901","BUMETANIDE","1MG","90","Select","Select",""],["","00006011231","JANUVIA","50MG","30","Select","Select",""],["","31722053101","TORSEMIDE","20MG","90","Select","Select",""],["","00069419068","REVATIO","20MG","90","Select","Select",""],["","00527221537","METOLAZONE","2.5MG","12","Select","Select",""],["","00603020922","MAG","400MG","120","Select","Select",""],["","08290320122","BD PEN NEEDL","32GX4MM","100","Select","Select",""],["","45802048678","DOCUSATE","100MG","30","Select","Select",""],["","31722070090","LOSARTAN","25MG","15","Select","Select",""],["","66733082259","INSULIN","100\/ML","3","Select","Select",""],["","69452015120","VITAMIN","50000UNT","12","Select","Select",""],["","00093226301","AMOXICILLIN","500MG","4","Select","Select",""],["","50742061610","METOPROL","50MG ER","90","Select","Select",""],["","70377002711","ATORVASTATIN ","10MG","30","Select","Select",""],["","00378064010","PREDNISONE ","5MG","30","Select","Select",""],["","00093551798","SILDENAFIL ","20MG","-90","Select","Select",""],["","00054016625","MYCOPHENOLAT ","500MG","-120","Select","Select",""],["","00781210201","TACROLIMUS ","0.5MG","-180","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","30","Select","Select",""],["","00002751001","HUMALOG ","100\/ML","30","Select","Select",""],["","00185012901","BUMETANIDE ","1MG","90","Select","Select",""],["","23155000201","HYDRALAZINE ","25MG","270","Select","Select",""],["","00603020922","MAG ","400MG","120","Select","Select",""],["","08290320122","BD  PEN NEEDL","32GX4MM","100","Select","Select",""],["","00002803101","GLUCAGON ","1MG","2","Select","Select",""],["","00006011231","JANUVIA ","50MG","30","Select","Select",""],["","66733082259","INSULIN ","100\/ML","3","Select","Select",""],["","31722053101","TORSEMIDE ","20MG","90","Select","Select",""],["","00069419068","REVATIO ","20MG","-90","Select","Select",""],["","45802048678","DOCUSATE ","100MG","30","Select","Select",""],["","00527221537","METOLAZONE ","2.5MG","12","Select","Select",""],["","31722070090","LOSARTAN ","25MG","15","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","12","Select","Select",""],["","50742061610","METOPROL ","50MG ER","90","Select","Select",""],["","00093226301","AMOXICILLIN ","500MG","4","Select","Select",""],["","55111072901","ALLOPURINOL","100MG","30","Select","Select",""],["","55111072901","ALLOPURINOL ","TAB 100MG","30","Select","Select",""],["","59267100002","PFIZER ","INJ COVID-19","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}