{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BASANT PAUDEL","gend":0,"add":"5516 SAMUELSON CT APT 22A","city":"VIRGINIA BEACH","state":"VA","zip":"23464-9998","dob":"1979-10-28","age":"","mstatus":"","insh":"1722063*01","cliId":"","pno":"757\/386-1609","cno":"757\/386-1609","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":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","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":["K64.9","R63.4","K29.70","Z20.822","K21.9","R74.8","H01.011","NO DATA","N40.3","K64.4","R05.","H04.123","R62.7","E55.9","K59.00","D18.03","N28.1","Z00.01","G90.09","K64.2","R60.0","R10.13","R14.0","K92.1"],"date":["2022-02-18","2022-11-16","2022-10-17","2021-11-08","2022-08-02","2022-11-16","2021-06-04","2021-06-04","2021-07-20","2021-07-20","2021-09-10","2021-09-10","2022-10-17","2022-08-11","2022-10-17","2022-07-21","2022-07-21","2021-09-16","2021-12-30","2022-07-26","2021-12-30","2022-11-16","2022-11-16","2022-11-16"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","42858000101","OXYCODONE","TAB 5MG","10","Select","Select",""],["","70677004201","SM","TAB 8.6-50MG","30","Select","Select",""],["","69315031228","PROCTO-MED","CRE HC 2.5%","28","Select","Select",""],["","29033000305","SUCRALFATE","TAB 1GM","90","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","68645056354","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","00536132710","ACETAMINOPHE","TAB 325MG","30","Select","Select",""],["","70710111001","CYPROHEPTAD","TAB 4MG","30","Select","Select",""],["","42806054701","VITAMIN","CAP 1.25MG","12","Select","Select",""],["","68382013201","TAMSULOSIN","CAP 0.4MG","30","Select","Select",""],["","16714079904","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","49281042150","FLUZONE","INJ 2021-22","0","Select","Select",""],["","65162068210","PHENAZOPYRID","TAB 200MG","6","Select","Select",""],["","00093081001","NORTRIPTYLIN","CAP 10MG","30","Select","Select",""],["","55111015930","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","45802086803","POLYETH","POW 3350 NF","510","Select","Select",""],["","61314063006","NEO\/POLY\/DEX","SUS 0.1% OP","5","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","70010010810","GABAPENTIN","CAP 100MG","60","Select","Select",""],["","68382078301","DOXAZOSIN","TAB 1MG","90","Select","Select",""],["","00527128201","DICYCLOMINE","TAB 20MG","30","Select","Select",""],["","65862078430","ESOMEPRA","CAP 40MG DR","30","Select","Select",""],["","16729017117","AMITRIPTYLIN","TAB 10MG","30","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","30","Select","Select",""],["","00172572960","FAMOTIDINE","TAB 40MG","30","Select","Select",""],["","64980032430","PROCTOZONE","CRE -HC 2.5%","30","Select","Select",""],["","00904645780","DOK","CAP 100MG","90","Select","Select",""],["","51672129801","KETOCONAZOLE","CRE 0.02","30","Select","Select",""],["","10631040701","PROCTOSOL","CRE 0.025","28","Select","Select",""],["","49281072010","FLUBLOK","INJ 2020-21","0","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","30","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}