{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMBER   L LACKEY","gend":1,"add":"4119 MCILWAINE DR","city":"PETERSBURG","state":"VA","zip":"23803-9998","dob":"1986-02-26","age":"","mstatus":"","insh":"20030816*01","cliId":"","pno":"804\/764-8240","cno":"804\/764-8240","email":"","ename":"","eno":"","pphy":"MATHERLEE, MICHAEL D MD","ppno":"434\/246-6100","pcpadd":"12454 HARTLEY ST","pcpcity":"STONY CREEK","pcpstate":"VA","pcpzip":23882,"pcpcounty":"","pcpid":104953,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/246-6614","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R53.81","R19.7","H66.93","Z72.0","R03.0","F43.12","F33.1","Z91.411","Z62.811","J45.909","F33.0","J30.2","I10.","E66.09","J30.1","J30.81","Z63.5","Z20.828","R11.0","G44.209","K29.50","NO DATA","D48.5","D23.112","I78.1","R10.84","R30.0","E78.5","K21.9","R10.30","Z68.41","Z79.899","L98.9","E66.3","R10.31","J18.9","K08.89","R10.13","K92.2","R68.84","L03.031","J06.9","Z20.822","U07.1","F17.200","R53.83"],"date":["2020-09-19","2020-12-22","2020-10-15","2020-10-15","2020-10-15","2020-07-16","2020-07-16","2020-07-16","2020-07-16","2021-03-09","2020-08-06","2020-05-06","2021-09-01","2021-03-09","2020-05-12","2020-05-12","2020-06-16","2021-01-15","2020-09-19","2020-09-19","2020-12-22","2021-06-12","2021-07-12","2021-07-12","2021-07-12","2020-12-22","2020-05-11","2021-04-29","2021-09-01","2020-11-20","2021-04-29","2021-03-09","2021-04-29","2021-04-29","2021-05-04","2020-03-08","2020-03-08","2020-11-06","2020-11-06","2021-05-14","2021-06-12","2021-09-01","2021-09-01","2021-09-09","2021-09-01","2021-09-01"],"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":[["","59310057922","PROAIR ","","8","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","31722072690","MONTELUKAST ","10MG","90","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","00143980305","DOXYCYCL ","100MG","20","Select","Select",""],["","00378363705","CETIRIZINE ","10MG","30","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","20","Select","Select",""],["","55111012701","CIPROFLOXACN ","500MG","10","Select","Select",""],["","00143312610","DICYCLOMINE ","10MG","28","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","10","Select","Select",""],["","00781808926","AZITHROMYCIN ","250MG","6","Select","Select",""],["","65862078330","ESOMEPRA ","20MG DR","14","Select","Select",""],["","00254101196","SUCRALFATE ","1GM\/10ML","420","Select","Select",""],["","68180071909","AMLODIPINE ","2.5MG","30","Select","Select",""],["","00406048410","APAP\/CODEINE ","300-30MG","12","Select","Select",""],["","52817033200","CYCLOBENZAPR ","10MG","15","Select","Select",""],["","55111012105","ATORVASTATIN ","10MG","90","Select","Select",""],["","00085113204","PROVENTIL ","HFA","7","Select","Select",""],["","00081067020","SUDAFED ","120MG CR","20","Select","Select",""],["","00143980305","DOXYCYCL","100MG","20","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","64380080707","IBUPROFEN","800MG","20","Select","Select",""],["","00378363705","CETIRIZINE","10MG","30","Select","Select",""],["","31722072690","MONTELUKAST","10MG","90","Select","Select",""],["","55111012701","CIPROFLOXACN","500MG","10","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","10","Select","Select",""],["","00781808926","AZITHROMYCIN","250MG","6","Select","Select",""],["","65862078330","ESOMEPRA","20MG DR","14","Select","Select",""],["","65162006205","SUCRALFATE","1GM\/10ML","420","Select","Select",""],["","68180071909","AMLODIPINE","2.5MG","90","Select","Select",""],["","00591079501","DICYCLOMINE","20MG","12","Select","Select",""],["","55111012105","ATORVASTATIN","10MG","90","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","15","Select","Select",""],["","00085113204","PROVENTIL","HFA","7","Select","Select",""],["","42806040021","METHYLPRED","4MG","21","Select","Select",""],["","00081067020","SUDAFED","120MG CR","20","Select","Select",""],["","00406048410","APAP\/CODEINE","300-30MG","12","Select","Select",""],["","63304069301","CLINDAMYCIN ","CAP 300MG","21","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","",""],["No","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":""}]}]}