{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MADHUBEN  B PATEL","gend":1,"add":"1228 EAGLEWOOD DR","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1944-01-01","age":"","mstatus":"","insh":"20038297*01","cliId":"","pno":"757\/927-8468","cno":"757\/927-8468","email":"","ename":"","eno":"","pphy":"PATEL, JITENDRA MD","ppno":"757\/471-3100","pcpadd":"2020S INDEPENDENCE SUITE 1","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23456,"pcpcounty":"","pcpid":101215,"pcpname":"Family and Internal Medical Center","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/471-3624","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","K59.01","R14.0","R10.13","K21.9","R77.1","H60.543","H90.3","E78.2","E11.9","R10.9","J20.9","M77.11","M25.521","R60.0","T78.40XA","F32.9","H60.92","R10.10","R05.","H35.363","H04.123","E03.9","J30.9","R93.89","E74.39","E55.9","D64.9"],"date":["2021-08-12","2020-06-11","2020-06-11","2020-06-11","2021-08-12","2021-01-15","2021-02-15","2021-02-15","2021-08-12","2020-09-24","2020-05-19","2020-02-28","2021-04-23","2021-04-23","2021-04-23","2020-05-19","2020-05-19","2020-01-25","2020-02-21","2021-01-06","2020-09-24","2020-09-24","2021-08-12","2021-08-12","2021-08-12","2021-08-12","2021-08-12","2021-08-12"],"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":[["","65862056090","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","53885013610","ONETOUCH ","LANCETS","100","Select","Select",""],["","64380073706","VITAMIN ","50000UNT","4","Select","Select",""],["","23155010210","METFORMIN ","500MG","30","Select","Select",""],["","16714068403","SIMVASTATIN ","40MG","30","Select","Select",""],["","31722072610","MONTELUKAST ","10MG","30","Select","Select",""],["","00781107810","ATENOLOL ","25MG","30","Select","Select",""],["","62542030104","HYD ","10-8\/5ML","70","Select","Select",""],["","24208063562","NEO\/POLY\/HC ","1% OTIC","10","Select","Select",""],["","31722063231","OSELTAMIVIR ","75MG","10","Select","Select",""],["","64380071206","BENZONATATE ","100MG","20","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","65862078430","ESOMEPRA ","40MG DR","90","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","00536116134","MUCUS ","30-600ER","20","Select","Select",""],["","43547028010","ESCITALOPRAM ","5MG","30","Select","Select",""],["","68645055254","LISINOPRIL ","10MG","30","Select","Select",""],["","00172572960","FAMOTIDINE ","40MG","90","Select","Select",""],["","67877019805","AMLODIPINE ","5MG","30","Select","Select",""],["","00378037201","CIMETIDINE ","400MG","90","Select","Select",""],["","42571012290","LEVOCETIRIZI ","5MG","30","Select","Select",""],["","00527058601","DICYCLOMINE ","10MG","90","Select","Select",""],["","00065427325","PAZEO ","0.70%","2","Select","Select",""],["","00093768432","OLOPATADINE ","0.20%","2","Select","Select",""],["","65162083366","DICLOFENAC ","1%","500","Select","Select",""],["","49281012065","FLUZONE ","PF 20-21","1","Select","Select",""],["","00065081604","PATADAY ","0.70%","2","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":""}]}]}