{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SYKIENG TIV","gend":0,"add":"401 DUNHAM MASSIE DR","city":"HAMPTON","state":"VA","zip":"23669-9998","dob":"1931-04-04","age":"","mstatus":"","insh":"20036282*01","cliId":"","pno":"851-6081","cno":"","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":"DAU T LE MD","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":["I10.","H40.1132","H01.001","H01.004","Z00.01","I48.0","I47.1","I49.3","M16.0","R05.3","E11.65","E11.9","Z79.4","R19.7","R07.89","J45.998","R05.","Z23.","I48.91","H04.123","N40.3","R07.9","I49.1","J06.9","H35.372","E11.3293","H34.11","H43.22","J45.909","K29.70","H02.409"],"date":["2021-11-03","2021-11-01","2021-11-01","2021-11-01","2021-05-12","2021-07-01","2021-07-01","2021-05-14","2021-11-03","2021-11-03","2021-11-03","2020-02-06","2020-02-04","2020-02-04","2021-07-09","2021-07-09","2021-07-09","2021-10-14","2019-07-24","2019-11-13","2019-08-07","2019-07-19","2019-07-31","2019-11-20","2019-12-02","2019-12-02","2019-12-02","2019-12-02","2019-04-02","2019-08-27","2019-11-13"],"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":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","24208046325","LATANOPROST","SOL 0.00005","2","Select","Select",""],["","57237000830","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","00186504031","NEXIUM","CAP 40MG","90","Select","Select",""],["","65862001005","METFORMIN","TAB 1000MG","60","Select","Select",""],["","68180098103","LISINOPRIL","TAB 20MG","30","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","33342015915","TAMSULOSIN","CAP 0.4MG","30","Select","Select",""],["","50742061510","METOPROL","TAB 25MG ER","30","Select","Select",""],["","67877057505","BENZONATATE","CAP 200MG","30","Select","Select",""],["","29300022019","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","68462039730","OMEPRAZOLE","CAP 40MG","90","Select","Select",""],["","00093720110","PRAVASTATIN","TAB 20MG","30","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","70436015541","PROMETHAZINE","SOL DM","150","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","14","Select","Select",""],["","65862020330","LOSARTAN","TAB 100MG","30","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","500","Select","Select",""],["","60432026415","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00173089310","TRELEGY","AER ELLIPTA","180","Select","Select",""],["","67877019705","AMLODIPINE","TAB 2.5MG","90","Select","Select",""],["","45802091939","CETIRIZINE","TAB 10MG","90","Select","Select",""],["","64380080307","RANITIDINE","TAB 150MG","30","Select","Select",""],["","","LOPERAMIDE","CAP 2MG","","Select","Select",""],["","00173069500","ADVAIR","AER 100\/50","60","Select","Select",""],["","66993058497","FLUTIC\/SALME","AER 100\/50","60","Select","Select",""],["","00378932032","WIXELA","AER 100\/50","60","Select","Select",""],["","16729009010","FINASTERIDE","TAB 5MG","30","Select","Select",""],["","69097091302","OMEPRA\/BICAR","CAP 20-1100","30","Select","Select",""],["","68382005001","MELOXICAM","TAB 7.5MG","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":""}]}]}