{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LIEN   T NGUYEN","gend":1,"add":"211 MANCHESTER DR","city":"HAMPTON","state":"VA","zip":"23666-9998","dob":"1943-08-12","age":"","mstatus":"","insh":"20041592*01","cliId":"","pno":"757\/927-3677","cno":"757\/927-3677","email":"","ename":"","eno":"","pphy":"JOYNER, AERIAN K NP","ppno":"757\/827-2025","pcpadd":"STE 300 4001 COLISEUM DR","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":700501,"pcpname":"SMG - Sentara Family & Internal Medicine Physicians - CarePlex West","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z23.","Z00.01","E11.65","I10.","B37.2","E78.2","J02.8","E11.40","F02.80","J31.0","L25.4","E55.9"],"date":["2020-10-27","2021-01-11","2021-06-28","2021-06-28","2021-06-28","2021-06-28","2020-10-19","2020-10-19","2021-03-29","2021-08-09","2021-08-09","2021-08-09"],"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":[["","68382076010","METFORMIN ","1000MG","60","Select","Select",""],["","64380080307","RANITIDINE ","150MG","60","Select","Select",""],["","45802091987","CETIRIZINE ","10MG","30","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","30","Select","Select",""],["","65862020190","LOSARTAN ","25MG","30","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00006027731","JANUVIA ","100MG","90","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","30","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","13668010290","DONEPEZIL ","5MG","30","Select","Select",""],["","67877057305","BENZONATATE ","100MG","60","Select","Select",""],["","00093720198","PRAVASTATIN ","20MG","90","Select","Select",""],["","51672128902","NYSTATIN ","100000","30","Select","Select",""],["","47781030301","NITROFURANTN ","100MG","10","Select","Select",""],["","69097081507","GABAPENTIN ","400MG","30","Select","Select",""],["","70710113803","FLUCONAZOLE ","100MG","3","Select","Select",""],["","51672404806","CLOTRIM\/BETA ","DIPROP","45","Select","Select",""],["","00168000680","TRIAMCINOLON ","0.10%","80","Select","Select",""],["","59779043262","NASAL ","30MG","18","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","12","Select","Select",""],["","68180072003","AMLODIPINE","5MG","30","Select","Select",""],["","45802091987","CETIRIZINE","10MG","30","Select","Select",""],["","65862020190","LOSARTAN","25MG","30","Select","Select",""],["","68382076010","METFORMIN","1000MG","60","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","64380080307","RANITIDINE","150MG","60","Select","Select",""],["","67877057305","BENZONATATE","100MG","60","Select","Select",""],["","13668010290","DONEPEZIL","5MG","30","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","00093720198","PRAVASTATIN","20MG","90","Select","Select",""],["","00006027731","JANUVIA","100MG","90","Select","Select",""],["","69097081507","GABAPENTIN","400MG","30","Select","Select",""],["","47781030301","NITROFURANTN","100MG","10","Select","Select",""],["","70710113803","FLUCONAZOLE","100MG","3","Select","Select",""],["","59779043262","NASAL","30MG","18","Select","Select",""],["","51672404806","CLOTRIM\/BETA","DIPROP","45","Select","Select",""],["","69452015120","VITAMIN","50000UNT","12","Select","Select",""],["","00168000680","TRIAMCINOLON","0.10%","80","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","30","Select","Select",""],["","51672128902","NYSTATIN","100000","30","Select","Select",""],["","68382025501","OXYBUTYNIN ","TAB 5MG ER","30","Select","Select",""],["","69842031278","8HR ","TAB 650MG","90","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":""}]}]}