{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BONNY   S LAMB","gend":1,"add":"18 HUBER ROAD APT 216","city":"NEWPORT NEWS","state":"VA","zip":"23601-9998","dob":"1980-08-23","age":"","mstatus":"","insh":"5857872*01","cliId":"","pno":"757\/696-9911","cno":"757\/696-9911","email":"","ename":"","eno":"","pphy":"DOWLING, NEQUITA A MD","ppno":"757\/827-1940","pcpadd":"2148 WEST MERCURY BOULEVARD","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":118380,"pcpname":"Riverside Medical Care Center - Mercury West","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"757\/240-3176","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J40.","K76.0","R07.9","E87.6","Z72.0","Z23.","I10.","E55.9","Z13.220","N89.8","F17.210","M51.36","K21.0","J30.1","R07.89","Z20.5","K21.9","F41.9","M62.830","Z03.818","D53.1","M54.5","D69.6","K13.79","M77.12","M54.16","G89.29","Z20.828","Z00.00","R71.8","E78.2","R87.810","M27.69","F17.200"],"date":["2020-05-05","2021-11-15","2020-04-14","2020-05-05","2020-04-14","2021-11-15","2021-11-15","2021-11-15","2020-11-17","2021-01-20","2021-11-15","2020-05-05","2020-05-05","2020-05-05","2020-05-27","2020-05-27","2021-10-02","2020-05-27","2020-05-27","2020-04-14","2021-01-13","2020-11-23","2021-11-15","2021-10-02","2020-11-02","2020-11-02","2020-11-02","2021-09-23","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2021-10-02","2021-10-02"],"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":[["","00093506105","HYDROXYZ ","25MG","30","Select","Select",""],["","00172572860","FAMOTIDINE ","20MG","60","Select","Select",""],["","62175011843","OMEPRAZOLE ","20MG","30","Select","Select",""],["","62037083101","METOPROL ","50MG ER","14","Select","Select",""],["","68382032001","POT  CHLORIDE","10MEQ ER","8","Select","Select",""],["","23155013525","DOXYCYC ","100MG","20","Select","Select",""],["","65162006205","SUCRALFATE ","1GM\/10ML","1200","Select","Select",""],["","31722053301","METHOCARBAM ","500MG","20","Select","Select",""],["","68180098003","LISINOPRIL ","10MG","30","Select","Select",""],["","76439021712","MAG ","400MG","90","Select","Select",""],["","00363015798","ASPIRIN ","325MG","30","Select","Select",""],["","00363010412","PAIN ","325MG","30","Select","Select",""],["","45963067611","METOPROLOL ","50MG ER","90","Select","Select",""],["","00591544305","PREDNISONE ","20MG","21","Select","Select",""],["","39328002430","LIDOCAINE ","4%","30","Select","Select",""],["","66685100100","AMOX\/K ","875-125","20","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","14","Select","Select",""],["","59651036205","IBUPROFEN ","800MG","30","Select","Select",""],["","57237000511","FLUCONAZOLE ","150MG","2","Select","Select",""],["","11534016503","FOLIC ","1MG","90","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","473","Select","Select",""],["","62037083101","METOPROL","50MG ER","14","Select","Select",""],["","68382032001","POT CHLORIDE","10MEQ ER","8","Select","Select",""],["","65162006205","SUCRALFATE","1GM\/10ML","1200","Select","Select",""],["","76439021712","MAG","400MG","90","Select","Select",""],["","00093506105","HYDROXYZ","25MG","30","Select","Select",""],["","00172572860","FAMOTIDINE","20MG","60","Select","Select",""],["","62175011843","OMEPRAZOLE","20MG","30","Select","Select",""],["","31722053301","METHOCARBAM","500MG","20","Select","Select",""],["","45963067611","METOPROLOL","50MG ER","90","Select","Select",""],["","39328002430","LIDOCAINE","4%","30","Select","Select",""],["","68180051303","LISINOPRIL","5MG","90","Select","Select",""],["","00591544305","PREDNISONE","20MG","21","Select","Select",""],["","66685100100","AMOX\/K","875-125","20","Select","Select",""],["","11534016503","FOLIC","1MG","90","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","2","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","14","Select","Select",""],["","00363015798","ASPIRIN","325MG","30","Select","Select",""],["","00363010412","PAIN","325MG","30","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","64380080707","IBUPROFEN","800MG","30","Select","Select",""],["","27808003602","HYDROCO\/APAP","7.5-325","36","Select","Select",""],["","00406051205","OXYCOD\/APAP","5-325MG","36","Select","Select",""],["","57237002801","AMOXICILLIN","500MG","40","Select","Select",""],["","23155013525","DOXYCYC","100MG","20","Select","Select",""],["","00406051205","OXYCOD\/APAP ","TAB 5-325MG","36","Select","Select",""],["","27808003602","HYDROCO\/APAP ","TAB 7.5-325","36","Select","Select",""],["","57237002801","AMOXICILLIN ","TAB 500MG","40","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","",""],["N\/A","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":""}]}]}