{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HUNG VU","gend":0,"add":"3508 SIERRA ARCH APT 104","city":"VIRGINIA BEACH","state":"VA","zip":"23453-9998","dob":"1961-10-22","age":"","mstatus":"","insh":"20041049*01","cliId":"","pno":"408\/772-2672","cno":"408\/772-2672","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":["C22.0","N17.9","E87.5","R74.0","S72.322K","M25.562","M76.61","S72.301K","Z23.","I73.9","I10.","E78.5","I25.2","I25.810","I42.9","I65.21","Z95.5","K74.69","I50.22","Z00.01","I25.10","I25.5","I50.9","Z95.1","D64.9","N39.0","R31.9","L03.115","M54.2","N18.2","R73.9","M47.22","M47.812","K29.70","M62.830","M47.817","G89.29","K74.60","E11.9","G25.81","R60.0","H35.62","H25.813","H04.123","H52.03","H52.223","H52.4","I08.1","M76.891","I65.23","Z48.3","R18.0","Q61.02","R91.1"],"date":["2021-09-13","2020-01-16","2020-01-16","2020-01-16","2020-07-21","2020-03-17","2020-06-23","2020-07-21","2020-09-18","2021-07-22","2021-07-22","2021-07-22","2021-07-22","2021-07-22","2021-07-22","2021-07-22","2021-07-22","2020-02-04","2020-02-04","2021-06-14","2021-05-19","2020-03-05","2020-06-25","2020-06-25","2020-03-05","2020-06-23","2020-06-23","2020-06-23","2020-09-15","2021-03-01","2021-03-01","2021-03-01","2021-04-19","2021-02-19","2021-05-19","2021-05-19","2020-03-17","2021-09-13","2020-11-12","2020-11-12","2021-04-19","2021-07-07","2021-07-07","2021-07-07","2021-07-07","2021-07-07","2021-07-07","2020-06-15","2021-08-05","2021-08-11","2021-09-13","2021-09-13","2021-09-13","2021-09-13"],"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":[["","16729021816","CLOPIDOGREL ","75MG","30","Select","Select",""],["","65862056090","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","70377000215","SIMVASTATIN ","10MG","30","Select","Select",""],["","68382013201","TAMSULOSIN ","0.4MG","30","Select","Select",""],["","65862020199","LOSARTAN ","25MG","60","Select","Select",""],["","00054429731","FUROSEMIDE ","20MG","60","Select","Select",""],["","65862014305","CARVEDILOL ","6.25MG","60","Select","Select",""],["","00172572860","FAMOTIDINE ","20MG","90","Select","Select",""],["","43598081115","CETIRIZINE ","10MG","60","Select","Select",""],["","16729013401","ALLOPURINOL ","100MG","90","Select","Select",""],["","00591544210","PREDNISONE ","10MG","10","Select","Select",""],["","00591532501","PROBEN\/COLCH ","500-0.5","30","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","30","Select","Select",""],["","50383026505","LOTEPREDNOL ","0.50%","5","Select","Select",""],["","52817033010","CYCLOBENZAPR ","5MG","30","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","12","Select","Select",""],["","43598043601","NITROGLYCERN ","0.4MG","100","Select","Select",""],["","24208029905","LOTEMAX ","0.50%","5","Select","Select",""],["","00363999315","ARTHRTS ","650MG ER","150","Select","Select",""],["","70954008510","CHLORZOXAZON ","500MG","30","Select","Select",""],["","16729021816","CLOPIDOGREL","75MG","90","Select","Select",""],["","68382013201","TAMSULOSIN","0.4MG","30","Select","Select",""],["","70377000215","SIMVASTATIN","10MG","30","Select","Select",""],["","00054429731","FUROSEMIDE","20MG","60","Select","Select",""],["","65862056090","PANTOPRAZOLE","40MG","30","Select","Select",""],["","65862020199","LOSARTAN","25MG","60","Select","Select",""],["","65862014305","CARVEDILOL","6.25MG","60","Select","Select",""],["","00172572860","FAMOTIDINE","20MG","90","Select","Select",""],["","43598081115","CETIRIZINE","10MG","60","Select","Select",""],["","00591544210","PREDNISONE","10MG","10","Select","Select",""],["","00591532501","PROBEN\/COLCH","500-0.5","30","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","30","Select","Select",""],["","16729013401","ALLOPURINOL","100MG","90","Select","Select",""],["","52817033010","CYCLOBENZAPR","5MG","30","Select","Select",""],["","69452015120","VITAMIN","50000UNT","12","Select","Select",""],["","00363999315","ARTHRTS","650MG ER","150","Select","Select",""],["","43598043601","NITROGLYCERN","0.4MG","100","Select","Select",""],["","70954008510","CHLORZOXAZON","500MG","30","Select","Select",""],["","50383026505","LOTEPREDNOL","0.50%","5","Select","Select",""],["","24208029905","LOTEMAX","0.50%","5","Select","Select",""],["","80777027398","MODERNA ","INJ COVID-19","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}