{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMIYA   J ISLAM","gend":1,"add":"4113 CLINTWOOD LN RESQSKILLS","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"2003-03-19","age":"","mstatus":"","insh":"2232463*01","cliId":"","pno":"757\/685-9999","cno":"757\/435-1342","email":"","ename":"","eno":"","pphy":"KHAN, GHAZALA Y MD","ppno":"757\/495-7420","pcpadd":"STE 114 4221 PLEASANT VALLEY","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23464,"pcpcounty":"","pcpid":102265,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/495-3917","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F90.0","Z01.419","Z11.3","F33.1","R50.9","R51.9","J02.9","Z30.017","F43.10","U07.1","Z00.129","Z30.9","Z20.828","Z11.8","N89.8","L29.2","R30.9","S42.402A","S49.92XA","B37.3"],"date":["2020-08-25","2021-01-06","2021-08-31","2020-07-14","2020-11-19","2020-11-19","2020-11-19","2020-08-25","2020-01-31","2021-03-23","2020-08-11","2020-09-08","2021-08-21","2021-07-14","2021-07-14","2021-07-14","2021-08-31","2021-02-07","2021-02-07","2021-08-31"],"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":[["","59417010410","VYVANSE ","40MG","30","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","28","Select","Select",""],["","65862094088","AUROVELA ","Jan-20","84","Select","Select",""],["","68462079935","NYSTAT\/TRIAM ","","30","Select","Select",""],["","00052433001","NEXPLANON ","68MG","1","Select","Select",""],["","00781808926","AZITHROMYCIN ","250MG","6","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","14","Select","Select",""],["","57237000511","FLUCONAZOLE ","150MG","2","Select","Select",""],["","00185012201","NITROFURANTN ","100MG","14","Select","Select",""],["","59417010410","VYVANSE","40MG","30","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","28","Select","Select",""],["","65862094088","AUROVELA","Jan-20","84","Select","Select",""],["","00052433001","NEXPLANON","68MG","1","Select","Select",""],["","00781808926","AZITHROMYCIN","250MG","6","Select","Select",""],["","68462079935","NYSTAT\/TRIAM","","30","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","14","Select","Select",""],["","00185012201","NITROFURANTN","100MG","14","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","2","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","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}