{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SYKIENG TIV","gend":0,"add":"401 DUNHAM MASSIE DR","city":"HAMPTON","state":"VA","zip":"23669-9998","dob":"1931-04-04","age":"","mstatus":"","insh":"20036282*01","cliId":"","pno":"851-6081","cno":"851-6081","email":"","ename":"","eno":"","pphy":"LE, DAU T MD","ppno":"757\/671-8746","pcpadd":"SUITE 104 5444 VIRGINIA BEACH BLVD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":671359,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/363-8626","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I48.0","E11.9","Z79.4","R19.7","R07.89","J45.998","R05.","I10.","H40.1132","I47.1","Z00.01","I49.3"],"date":["2021-07-01","2020-02-06","2020-02-04","2020-02-04","2021-07-09","2021-07-09","2021-07-09","2021-07-01","2021-04-26","2021-07-01","2021-05-12","2021-05-14"],"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":[["","00186037020","SYMBICORT ","160-4.5","10","Select","Select",""],["","65862001005","METFORMIN ","1000MG","60","Select","Select",""],["","68462039730","OMEPRAZOLE ","40MG","30","Select","Select",""],["","00093720110","PRAVASTATIN ","20MG","30","Select","Select",""],["","57237000830","MIRTAZAPINE ","15MG","30","Select","Select",""],["","24208046325","LATANOPROST ","0.01%","2","Select","Select",""],["","33342015915","TAMSULOSIN ","0.4MG","30","Select","Select",""],["","68180098103","LISINOPRIL ","20MG","30","Select","Select",""],["","64380071206","BENZONATATE ","100MG","60","Select","Select",""],["","16714085202","METOPROL ","25MG ER","30","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","48","Select","Select",""],["","00093031101","LOPERAMIDE ","2MG","24","Select","Select",""],["","67877021901","CEPHALEXIN ","500MG","30","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","00186504031","NEXIUM ","40MG","90","Select","Select",""],["","65862057490","MONTELUKAST ","10MG","90","Select","Select",""],["","00536445505","RANITIDINE ","150MG","30","Select","Select",""],["","57237000830","MIRTAZAPINE","15MG","30","Select","Select",""],["","68462039730","OMEPRAZOLE","40MG","30","Select","Select",""],["","00186037020","SYMBICORT","160-4.5","10","Select","Select",""],["","00527260043","METOPROL","25MG ER","30","Select","Select",""],["","68180098103","LISINOPRIL","20MG","30","Select","Select",""],["","00536445505","RANITIDINE","150MG","30","Select","Select",""],["","60505016907","PRAVASTATIN","20MG","30","Select","Select",""],["","33342015915","TAMSULOSIN","0.4MG","30","Select","Select",""],["","65862001005","METFORMIN","1000MG","60","Select","Select",""],["","24208046325","LATANOPROST","0.01%","2","Select","Select",""],["","64380071206","BENZONATATE","100MG","60","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","16","Select","Select",""],["","00093031101","LOPERAMIDE","2MG","24","Select","Select",""],["","67877021901","CEPHALEXIN","500MG","30","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","00186504031","NEXIUM","40MG","90","Select","Select",""],["","65862057490","MONTELUKAST","10MG","90","Select","Select",""],["","00173089310","TRELEGY ","AER ELLIPTA","180","Select","Select",""],["","70436015541","PROMETHAZINE ","SOL DM","150","Select","Select",""],["","00143924920","AMOX\/K ","TAB 875-125","14","Select","Select",""],["","65862020330","LOSARTAN ","TAB 100MG","30","Select","Select",""],["","67877019705","AMLODIPINE ","TAB 2.5MG","30","Select","Select",""],["","45802091939","CETIRIZINE ","TAB 10MG","90","Select","Select",""],["","69097052444","DICLOFENAC ","GEL 0.01","500","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","",""],["Yes","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":""}]}]}