{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"THINH   X TRAN","gend":0,"add":"788 CHIPPENDALE DR","city":"VIRGINIA BEACH","state":"VA","zip":"23455-9998","dob":"1985-04-30","age":"","mstatus":"","insh":"20041038*01","cliId":"","pno":"831\/205-9534","cno":"831\/205-9534","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":["F20.0","F23.","M62.82","E11.9","R03.0","F17.200","Z79.4","E03.9","F25.0","F22.","J02.9","F17.210","M54.5","R78.89","F25.9","R45.1","F31.9","G89.29","M54.2","M54.9","D72.828","R07.9","Z91.041","Z79.84","Z79.899","Z82.49","F29.","Z88.8","R06.02","I10.","J02.8","R46.89","Z00.00","R74.8","R00.0","F41.9"],"date":["2020-04-19","2020-04-14","2020-04-15","2020-06-15","2020-04-14","2020-04-14","2020-04-14","2020-06-15","2021-09-01","2020-06-15","2020-06-16","2020-06-16","2021-06-18","2021-06-18","2020-06-15","2020-04-11","2020-04-11","2020-04-11","2020-04-11","2020-04-11","2020-04-11","2020-04-11","2020-06-15","2020-04-11","2020-04-11","2020-04-11","2020-04-11","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-04-11","2020-04-11","2020-04-11","2020-06-27","2020-06-27"],"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":[["","10370010250","BUPROPN ","300MG XL","30","Select","Select",""],["","61874013030","VRAYLAR ","3MG","30","Select","Select",""],["","00378180010","LEVOTHYROXIN ","25MCG","30","Select","Select",""],["","43547027110","ROPINIROLE ","2MG","30","Select","Select",""],["","00527179101","FLUPHENAZINE ","10MG","60","Select","Select",""],["","68382075810","METFORMIN ","500MG","60","Select","Select",""],["","65162019050","NAPROXEN ","500MG","60","Select","Select",""],["","65862008601","BISOPROL ","5MG","90","Select","Select",""],["","59746017710","CYCLOBENZAPR ","10MG","30","Select","Select",""],["","49884072501","BUSPIRONE ","7.5MG","60","Select","Select",""],["","00591354160","BUPROPION ","150MG SR","30","Select","Select",""],["","67877019805","AMLODIPINE ","5MG","30","Select","Select",""],["","00603243721","BENZTROPINE ","0.5MG","60","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","473","Select","Select",""],["","68180016013","AZITHROMYCIN ","250MG","6","Select","Select",""],["","59267100002","PFIZER ","COVID-19","0","Select","Select",""],["","70461032003","FLUCLVX ","2020-21","0","Select","Select",""],["","58160082152","ENGERIX-B ","20MCG\/ML","1","Select","Select",""],["","58160084252","BOOSTRIX ","","1","Select","Select",""],["","00378020810","FUROSEMIDE ","20MG","30","Select","Select",""],["","00006483703","PNEUMOVAX ","25\/0.5","0","Select","Select",""],["","43547027110","ROPINIROLE","2MG","30","Select","Select",""],["","68382075810","METFORMIN","500MG","60","Select","Select",""],["","61874013030","VRAYLAR","3MG","30","Select","Select",""],["","00378180010","LEVOTHYROXIN","25MCG","30","Select","Select",""],["","10370010250","BUPROPN","300MG XL","30","Select","Select",""],["","00591565810","CYCLOBENZAPR","10MG","30","Select","Select",""],["","00603243721","BENZTROPINE","0.5MG","60","Select","Select",""],["","00527179101","FLUPHENAZINE","10MG","60","Select","Select",""],["","00591354160","BUPROPION","150MG SR","30","Select","Select",""],["","67877019805","AMLODIPINE","5MG","30","Select","Select",""],["","65162019050","NAPROXEN","500MG","20","Select","Select",""],["","65862008601","BISOPROL","5MG","90","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","49884072501","BUSPIRONE","7.5MG","60","Select","Select",""],["","70461032003","FLUCLVX","2020-21","0","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","00378020810","FUROSEMIDE","20MG","30","Select","Select",""],["","58160084252","BOOSTRIX","","1","Select","Select",""],["","00006483703","PNEUMOVAX","25\/0.5","0","Select","Select",""],["","58160082152","ENGERIX-B","20MCG\/ML","1","Select","Select",""],["","68180035109","SERTRALINE ","TAB 25MG","30","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","30","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":""}]}]}