{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HOAN PHUONG","gend":1,"add":"7303 CAMP ALGER AVE","city":"FALLS CHURCH","state":"VA","zip":"22042-9998","dob":"1954-12-05","age":"","mstatus":"","insh":"20064870*01","cliId":"","pno":"571\/242-7751","cno":"571\/242-7751","email":"","ename":"","eno":"","pphy":"PHAM, NICK MD","ppno":"703\/533-7673","pcpadd":"SUITE F 6408 SEVEN CORNERS PL","pcpcity":"FALLS CHURCH","pcpstate":"VA","pcpzip":22044,"pcpcounty":"","pcpid":172300,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"703\/533-7675","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25.519","E78.5","Z00.01","I10.","B18.1","E55.9","K83.1","E87.1","C78.7","D64.9","R62.7","E86.1","R74.8","R59.9","Z79.899","Z20.822","R17.","R19.00","R93.89","N39.0","M17.0","K76.89","Z51.89","R16.0","B96.81","J02.9","R05.","J30.1","R10.816","K74.60","C22.8","Z03.818","J20.9","I73.00","C22.0","D13.4","I08.2","NO DATA","I37.1","A41.9","R11.2","R50.9","R53.83","Z11.52","E87.0","R10.10","L20.89","L50.1","A41.81","K80.33","T85.520A","T50.8X5A","E87.6","D47.3","B95.2","K80.51","R11.0","R19.7","B19.10","K74.5","K80.40","B18.2","R93.5","G90.09","Z46.82","Z80.3"],"date":["2020-04-13","2021-04-22","2021-04-22","2021-10-11","2021-09-13","2021-04-22","2021-10-11","2021-09-14","2021-06-17","2021-08-20","2021-06-17","2021-08-20","2021-06-17","2021-06-17","2021-10-11","2021-08-18","2021-06-19","2021-06-17","2021-06-17","2020-07-21","2020-08-04","2020-08-04","2021-06-19","2021-07-06","2020-07-28","2020-09-04","2021-08-18","2021-07-26","2020-03-11","2021-07-06","2021-09-13","2020-12-14","2020-03-04","2020-03-04","2021-10-11","2021-06-18","2021-08-22","2021-08-23","2021-08-22","2021-08-21","2021-08-18","2021-08-18","2021-08-18","2021-08-18","2021-08-19","2021-08-19","2021-05-24","2021-05-24","2021-08-20","2021-08-20","2021-08-20","2021-08-20","2021-08-20","2021-08-20","2021-08-23","2021-08-21","2021-08-30","2021-08-08","2021-09-13","2021-09-13","2021-09-13","2021-09-13","2021-06-19","2021-10-25","2021-10-11","2021-10-11"],"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":[["","00527193206","CLARITHROMYC ","500MG","28","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","90","Select","Select",""],["","50742062001","NIFEDIPINE ","30MG ER","30","Select","Select",""],["","68180016013","AZITHROMYCIN ","250MG","6","Select","Select",""],["","60432027516","BROM\/PSE\/DM ","","150","Select","Select",""],["","50111033301","METRONIDAZOL ","250MG","56","Select","Select",""],["","55111015810","OMEPRAZOLE ","20MG","28","Select","Select",""],["","58657050016","CODEINE\/GG ","10-100\/5","150","Select","Select",""],["","00093310905","AMOXICILLIN ","500MG","56","Select","Select",""],["","65162019050","NAPROXEN ","500MG","20","Select","Select",""],["","69097015907","MELOXICAM ","15MG","30","Select","Select",""],["","00093770198","LEVOCETIRIZI ","5MG","30","Select","Select",""],["","65862050320","AMOX\/K ","875-125","14","Select","Select",""],["","65862042130","TENOFOVIR ","300MG","30","Select","Select",""],["","65862020290","LOSARTAN ","50MG","90","Select","Select",""],["","33342002208","LEVOFLOXACIN ","500MG","16","Select","Select",""],["","68462010630","ONDANSETRON ","8MG","21","Select","Select",""],["","69238152301","TETRACYCLINE ","500MG","56","Select","Select",""],["","47781030301","NITROFURANTN ","100MG","14","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","1","Select","Select",""],["","00093117701","NEOMYCIN ","500MG","6","Select","Select",""],["","33342032815","TRIAMCINOLON ","0.50%","30","Select","Select",""],["","70377002711","ATORVASTATIN ","10MG","90","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","48","Select","Select",""],["","52268001201","SUPREP ","PREP KIT","354","Select","Select",""],["","45802075930","PROMETHAZINE ","25MG","5","Select","Select",""],["","52268020101","SUTAB ","","24","Select","Select",""],["","08290306547","BD ","0.90%","300","Select","Select",""],["","00093005805","TRAMADOL ","50MG","21","Select","Select",""],["","55566670001","CLENPIQ ","","320","Select","Select",""],["","55150011720","AMP-SULBACTA ","2-1GM","21","Select","Select",""],["","68180072003","AMLODIPINE","5MG","30","Select","Select",""],["","50742062001","NIFEDIPINE","30MG ER","30","Select","Select",""],["","58657050016","CODEINE\/GG","10-100\/5","150","Select","Select",""],["","00527193206","CLARITHROMYC","500MG","28","Select","Select",""],["","00093310905","AMOXICILLIN","500MG","56","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","28","Select","Select",""],["","65162019050","NAPROXEN","500MG","20","Select","Select",""],["","69097015907","MELOXICAM","15MG","30","Select","Select",""],["","65862050320","AMOX\/K","875-125","14","Select","Select",""],["","47781030301","NITROFURANTN","100MG","14","Select","Select",""],["","69238152301","TETRACYCLINE","500MG","56","Select","Select",""],["","60432027516","BROM\/PSE\/DM","","150","Select","Select",""],["","50111033301","METRONIDAZOL","250MG","56","Select","Select",""],["","65862020290","LOSARTAN","50MG","90","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","65862042130","TENOFOVIR","300MG","30","Select","Select",""],["","00093770198","LEVOCETIRIZI","5MG","30","Select","Select",""],["","33342032815","TRIAMCINOLON","0.50%","30","Select","Select",""],["","52268001201","SUPREP","PREP KIT","354","Select","Select",""],["","33342002208","LEVOFLOXACIN","500MG","16","Select","Select",""],["","70377002711","ATORVASTATIN","10MG","90","Select","Select",""],["","68462010630","ONDANSETRON","8MG","21","Select","Select",""],["","00093117701","NEOMYCIN","500MG","6","Select","Select",""],["","55566670001","CLENPIQ","","320","Select","Select",""],["","08290306547","BD","0.90%","300","Select","Select",""],["","45802075930","PROMETHAZINE","25MG","5","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","48","Select","Select",""],["","52268020101","SUTAB","","24","Select","Select",""],["","55150011720","AMP-SULBACTA","2-1GM","21","Select","Select",""],["","00093005805","TRAMADOL","50MG","21","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","61958040101","VIREAD ","TAB 300MG","30","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","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":[[["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":""}]}]}