{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SITAMAHALAKS   D ARASUR","gend":1,"add":"12601 BAYHILL DR","city":"CHESTER","state":"VA","zip":"23836-9998","dob":"1948-11-17","age":"","mstatus":"","insh":"20023235*01","cliId":"","pno":"804\/530-2422","cno":"804\/530-2422","email":"","ename":"","eno":"","pphy":"GEORGE, LEELAMMA MD","ppno":"804\/526-8640","pcpadd":"215 TEMPLE AVE","pcpcity":"COLONIAL HEIGHTS","pcpstate":"VA","pcpzip":23834,"pcpcounty":"","pcpid":127805,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/526-4321","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":[]},{"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":[["","65862035790","CLOPIDOGREL ","75MG","30","Select","Select",""],["","00006011231","JANUVIA ","50MG","30","Select","Select",""],["","50742061610","METOPROL ","50MG ER","30","Select","Select",""],["","70377000712","ROSUVASTATIN ","10MG","30","Select","Select",""],["","68382075810","METFORMIN ","500MG","60","Select","Select",""],["","65862050220","AMOX\/K ","500-125","21","Select","Select",""],["","50383026505","LOTEPREDNOL ","0.50%","5","Select","Select",""],["","00143983610","PENICILLN ","500MG","28","Select","Select",""],["","60758011905","PREDNISOLONE ","1% OP","5","Select","Select",""],["","11980017405","PRED ","0.12% OP","5","Select","Select",""],["","71776010005","FLAREX ","0.1% OP","5","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","90","Select","Select",""],["","00998061505","MAXIDEX ","0.1% OP","5","Select","Select",""],["","24208050707","LOTEMAX ","0.38%","5","Select","Select",""],["","59779056813","DRY-EYE ","NIGHTTIM","4","Select","Select",""],["","00065924007","DUREZOL ","0.05%","5","Select","Select",""],["","61314023710","CROMOLYN ","4% OP","10","Select","Select",""],["","55111032101","GLIMEPIRIDE ","2MG","90","Select","Select",""],["","64980030550","DENTA ","PLUS","51","Select","Select",""],["","00093310905","AMOXICILLIN ","500MG","28","Select","Select",""],["","45963067696","METOPROLOL ","50MG ER","90","Select","Select",""],["","70069000701","OLOPATADINE ","0.10%","5","Select","Select",""],["","70377000712","ROSUVASTATIN","10MG","30","Select","Select",""],["","50742061610","METOPROL","50MG ER","30","Select","Select",""],["","68382075810","METFORMIN","500MG","60","Select","Select",""],["","00006011231","JANUVIA","50MG","30","Select","Select",""],["","65862035790","CLOPIDOGREL","75MG","30","Select","Select",""],["","65862050220","AMOX\/K","500-125","21","Select","Select",""],["","00143983610","PENICILLN","500MG","28","Select","Select",""],["","11980017405","PRED","0.12% OP","5","Select","Select",""],["","60758011905","PREDNISOLONE","1% OP","5","Select","Select",""],["","68180072003","AMLODIPINE","5MG","90","Select","Select",""],["","50383026505","LOTEPREDNOL","0.50%","5","Select","Select",""],["","00998061505","MAXIDEX","0.1% OP","5","Select","Select",""],["","24208050707","LOTEMAX","0.38%","5","Select","Select",""],["","59779056813","DRY-EYE","NIGHTTIM","4","Select","Select",""],["","00065924007","DUREZOL","0.05%","5","Select","Select",""],["","61314023710","CROMOLYN","4% OP","10","Select","Select",""],["","64980030550","DENTA","PLUS","51","Select","Select",""],["","71776010005","FLAREX","0.1% OP","5","Select","Select",""],["","55111032101","GLIMEPIRIDE","2MG","90","Select","Select",""],["","45963067696","METOPROLOL","50MG ER","90","Select","Select",""],["","00093310905","AMOXICILLIN","500MG","28","Select","Select",""],["","70069000701","OLOPATADINE","0.10%","5","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","",""],["No","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":""}]}]}