{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HOA  L NGUYEN","gend":1,"add":"6 E LEWIS ROAD","city":"HAMPTON","state":"VA","zip":"23666-9998","dob":"1967-10-10","age":"","mstatus":"","insh":"20032742*01","cliId":"","pno":7578848092,"cno":7578848092,"email":"","ename":"","eno":"","pphy":"LE, DAU T MD","ppno":7576718746,"pcpadd":"SUITE 104 5444 VIRGINIA BEACH BLVD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23462-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7573638626,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L89.153","G82.20","S24.102A","L89.154","N39.46","R39.81","R21.","Z99.3","N39.0","NO DATA","R10.12","R10.32","R03.0","R15.9","N31.9","L89.152","H40.1134","H04.123","Z00.01","E11.65","J31.0","L89.312","E11.9","Z79.4","M62.830","M06.252","L89.893","N30.01","E55.9","L25.3","Z79.899"],"date":["2023-03-29","2023-04-03","2023-03-29","2023-03-29","2022-02-04","2023-04-03","2023-04-03","2023-04-03","2021-11-08","2021-11-08","2021-11-08","2021-11-08","2021-11-08","2023-01-02","2023-01-02","2023-01-19","2023-04-06","2023-04-06","2023-02-20","2022-07-13","2021-05-24","2021-05-24","2023-04-06","2022-08-10","2021-11-15","2021-11-15","2021-11-15","2022-07-13","2022-07-13","2022-07-13","2022-08-10"],"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":[["","16571040250","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","08290320550","BD PEN NEEDL","MIS 32GX4MM","200","Select","Select",""],["","00002879959","HUMALOG KWIK","INJ 100\/ML","15","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","15","Select","Select",""],["","62332002791","LOSARTAN POT","TAB 25MG","90","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","30","Select","Select",""],["","00832105410","BACLOFEN","10 MG","60","Select","Select",""],["","45802048678","DOCUSATE SOD","CAP 100MG","30","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA","100","Select","Select",""],["","45802025735","MOMETASONE","CRE 0.001","45","Select","Select",""],["","67877025130","TRIAMCINOLON","CRE 0.001","80","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","30","Select","Select",""],["","80681013500","ZINC","CAP 220MG","90","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","100","Select","Select",""],["","10939086944","VITAMIN D3","CAP 5000UNIT","30","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","14","Select","Select",""],["","80777028299","MODERNA BIVA","INJ BA4\/BA5","0","Select","Select",""],["","49281072210","FLUBLOK QUAD","INJ 2022-23","0","Select","Select",""],["","33342032980","TRIAMCINOLONE ACETONIDE","0.1 %","80","Select","Select",""],["","49502039475","INSULIN GLARGINE-YFGN","100\/ML (3)","15","Select","Select",""],["","53885024510","ONETOUCH ULTRA TEST STRIP","","100","Select","Select",""],["","62332002791","LOSARTAN POTASSIUM","25 MG","90","Select","Select",""],["","00002879959","HUMALOG KWIKPEN U-","100 100\/ML","15","Select","Select",""],["","08290320550","NANO","2ND GEN PEN NEEDLE 32GX 5\/32\"","200","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","100\/ML (3)","15","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":""}]}]}