{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHERYL   F RONQUILLO","gend":1,"add":"PO BOX 741","city":"RUTHER GLEN","state":"VA","zip":"22546-9998","dob":"1963-06-24","age":"","mstatus":"","insh":"20034289*01","cliId":"","pno":"804\/869-8814","cno":"804\/869-8814","email":"","ename":"","eno":"","pphy":"GUIRGUIS, EKRAM G MD","ppno":"804\/448-0198","pcpadd":"SUITE 100 8051 PROSPERITY WAY","pcpcity":"RUTHER GLEN","pcpstate":"VA","pcpzip":22546,"pcpcounty":"","pcpid":151449,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"804\/299-6023","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/448-0598","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L25.9","Z00.00","Z71.89","Z71.3","F32.9","J44.9","M25.50","Z23.","G47.00","Z12.39","Z12.11","M81.0","K21.0","J44.1","J32.9","J30.89","Z87.891","M51.36","M47.816","M54.5","R06.02","R07.89","R07.9","R06.00","R93.89","R11.2","R00.0","M06.9"],"date":["2021-05-25","2020-02-04","2020-02-04","2020-02-04","2020-02-04","2021-08-11","2020-02-04","2021-06-15","2020-02-04","2020-02-04","2020-02-04","2020-02-04","2020-02-04","2021-08-20","2020-07-20","2021-08-20","2021-08-11","2020-02-17","2020-02-17","2020-02-17","2020-11-03","2020-11-16","2020-11-16","2020-11-16","2021-08-20","2021-08-11","2021-08-11","2021-08-11"],"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":[["","65862032904","ALENDRONATE ","70MG","4","Select","Select",""],["","87701040813","MELATONIN ","3MG","60","Select","Select",""],["","68001039800","FAMOTIDINE ","40MG","30","Select","Select",""],["","13668011005","DULOXETINE ","30MG","30","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00173088710","TRELEGY ","ELLIPTA","60","Select","Select",""],["","00904323393","CALCIUM\/D ","600-400","30","Select","Select",""],["","59746017310","PREDNISONE ","10MG","30","Select","Select",""],["","16571020150","DICLOFENAC ","75MG DR","60","Select","Select",""],["","50111078751","AZITHROMYCIN ","250MG","6","Select","Select",""],["","00832105415","BACLOFEN ","10MG","60","Select","Select",""],["","42806031205","DOXYCYCL ","100MG","10","Select","Select",""],["","76204020025","ALBUTEROL ","0.08%","225","Select","Select",""],["","00603188016","LIDOCAINE ","5%","30","Select","Select",""],["","42806040021","METHYLPRED ","4MG","21","Select","Select",""],["","68462015713","ONDANSETRON ","4MG ODT","20","Select","Select",""],["","45802065078","LORATADINE ","10MG","30","Select","Select",""],["","49035061246","ALLERGY ","10MG","30","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","87701040813","MELATONIN","3MG","60","Select","Select",""],["","13668011005","DULOXETINE","30MG","30","Select","Select",""],["","00172572960","FAMOTIDINE","40MG","30","Select","Select",""],["","00173088710","TRELEGY","ELLIPTA","60","Select","Select",""],["","65862032904","ALENDRONATE","70MG","4","Select","Select",""],["","16571020150","DICLOFENAC","75MG DR","60","Select","Select",""],["","00832105415","BACLOFEN","10MG","60","Select","Select",""],["","59746017310","PREDNISONE","10MG","30","Select","Select",""],["","50111078751","AZITHROMYCIN","250MG","6","Select","Select",""],["","42806031205","DOXYCYCL","100MG","10","Select","Select",""],["","00603188016","LIDOCAINE","5%","30","Select","Select",""],["","00904323393","CALCIUM\/D","600-400","30","Select","Select",""],["","76204020025","ALBUTEROL","0.08%","225","Select","Select",""],["","42806040021","METHYLPRED","4MG","21","Select","Select",""],["","68462015713","ONDANSETRON","4MG ODT","20","Select","Select",""],["","49035061246","ALLERGY","10MG","30","Select","Select",""],["","45802065078","LORATADINE","10MG","30","Select","Select",""],["","10702000709","CYCLOBENZAPR ","TAB 10MG","30","Select","Select",""],["","00093505698","ATORVASTATIN ","TAB 10MG","90","Select","Select",""],["","45802006436","TRIAMCINOLON ","CRE 0.001","240","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","",""],["Yes","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":""}]}]}