{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GUILLERMO ARTEAGA","gend":0,"add":"169 HOLLAND DR","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1965-12-06","age":"","mstatus":"","insh":"20040430*01","cliId":"","pno":"757\/319-3803","cno":"757\/319-3803","email":"","ename":"","eno":"","pphy":"CHAKRABORTTY, SAGHANA B MD","ppno":"757\/738-1300","pcpadd":"4421 VA BEACH BLVD SUITE 114","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":207903,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/687-3202","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F25.0","Z23.","Z00.00","I10.","E78.5","E66.9","N40.1","N39.498","R35.0","R32.","N40.0","R33.9","D30.01","F25.9","R79.89","Z68.30","Z12.11","J30.9","Z12.5","Z79.899"],"date":["2021-09-30","2021-06-04","2021-03-26","2021-03-26","2021-06-04","2020-02-03","2020-10-15","2020-02-03","2020-10-15","2021-09-14","2021-03-18","2021-03-18","2021-03-18","2021-06-30","2021-06-04","2021-03-26","2021-03-26","2020-07-15","2020-10-13","2021-02-02"],"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":[["","57237001401","TAMSULOSIN ","0.4MG","30","Select","Select",""],["","68382025601","OXYBUTYNIN ","10MG ER","30","Select","Select",""],["","13107015590","PAROXETINE ","20MG","30","Select","Select",""],["","43547027010","ROPINIROLE ","1MG","90","Select","Select",""],["","66993068530","OLANZAPINE ","20MG","30","Select","Select",""],["","55111053401","DIVALPROEX ","500MG ER","60","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","30","Select","Select",""],["","70377000315","SIMVASTATIN ","20MG","30","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","00093310905","AMOXICILLIN ","500MG","30","Select","Select",""],["","00074712613","DEPAKOTE ","500MG","60","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","57237001401","TAMSULOSIN","0.4MG","30","Select","Select",""],["","68382025601","OXYBUTYNIN","10MG ER","30","Select","Select",""],["","13107015590","PAROXETINE","20MG","30","Select","Select",""],["","68180072003","AMLODIPINE","5MG","30","Select","Select",""],["","43547027010","ROPINIROLE","1MG","30","Select","Select",""],["","55111053401","DIVALPROEX","500MG ER","60","Select","Select",""],["","66993068530","OLANZAPINE","20MG","30","Select","Select",""],["","70377000315","SIMVASTATIN","20MG","30","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","00093310905","AMOXICILLIN","500MG","30","Select","Select",""],["","00074712613","DEPAKOTE","500MG","60","Select","Select",""],["","49281042050","FLUZONE","2020-21","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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}