{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TIFFANY   L BOWDION","gend":1,"add":"32467 RIVERDALE DR LOT 120","city":"FRANKLIN","state":"VA","zip":"23851-9998","dob":"1985-11-13","age":"","mstatus":"","insh":"8844380*01","cliId":"","pno":"757\/998-5497","cno":"757\/998-5497","email":"","ename":"","eno":"","pphy":"RAMOLIA, MANSUKHLAL R MD","ppno":"757\/483-6401","pcpadd":"4035 TAYLOR RD #K","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23321,"pcpcounty":"","pcpid":210204,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/686-3025","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["A41.9","L03.115","F31.9","E66.01","Z68.42","F31.81","Z68.43","R59.0","I10.","D50.9","E86.0","F43.10","G89.29","M54.5","K21.9","F17.210","M54.9","L40.9","Z98.1","R65.10","M96.1","M53.87","M17.9","G43.009","R63.5","R21.","M79.89","J02.9","Z83.3","E66.9","J45.909","G25.81","Z88.0","Z88.5","Z88.6","Z88.8","Z68.41","Z79.82","Z79.51","Z79.899","Z83.49","R52.","M70.62","J06.9","F31.62","Z71.89","F41.1","F43.12","R11.2","F51.04","M79.606","E87.6","G89.4","J45.20","Z80.9","Z82.5","M79.604","K63.5","L65.9","Z00.00","Z23.","R05.","R10.12","F32.9","N92.0","Z71.9"],"date":["2020-08-05","2020-08-07","2020-08-04","2020-08-05","2020-08-04","2020-08-07","2020-08-05","2020-08-05","2021-05-08","2020-12-02","2020-08-05","2020-08-05","2020-08-07","2021-09-07","2021-05-08","2021-05-08","2020-08-05","2021-01-25","2020-08-05","2020-08-06","2021-09-07","2021-09-07","2021-09-07","2020-12-23","2020-12-02","2020-12-23","2020-12-23","2021-05-08","2021-05-08","2021-05-08","2021-05-08","2021-05-08","2021-05-08","2021-05-08","2021-05-08","2021-05-08","2021-05-08","2021-05-08","2021-05-08","2021-05-08","2021-05-08","2020-08-05","2021-09-07","2020-02-21","2020-07-16","2020-07-16","2020-07-16","2020-07-16","2020-07-16","2020-07-16","2020-08-01","2020-08-01","2020-08-01","2020-08-01","2020-08-01","2020-08-01","2020-08-01","2020-11-04","2020-11-04","2020-11-04","2020-11-04","2020-09-03","2020-01-15","2020-01-15","2020-01-15","2021-01-25"],"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":[["","29300011201","LAMOTRIGINE ","100MG","60","Select","Select",""],["","00591252001","CHLORZOXAZON ","500MG","90","Select","Select",""],["","00363193126","MILK ","400\/5ML","450","Select","Select",""],["","64380080807","IBUPROFEN ","600MG","15","Select","Select",""],["","00363040511","WAL-MUCIL ","100%","660","Select","Select",""],["","43598081115","CETIRIZINE ","10MG","20","Select","Select",""],["","00781808926","AZITHROMYCIN ","250MG","6","Select","Select",""],["","00224180107","KONSYL ","100%","450","Select","Select",""],["","69543013611","TRAMADOL ","50MG","90","Select","Select",""],["","64380071206","BENZONATATE ","100MG","15","Select","Select",""],["","69238126601","OSELTAMIVIR ","75MG","10","Select","Select",""],["","61874013030","VRAYLAR ","3MG","30","Select","Select",""],["","00054004641","IPRATROPIUM ","0.06%","15","Select","Select",""],["","65162024709","CHLORTHALID ","25MG","15","Select","Select",""],["","11917018705","FLUTICASONE ","50MCG","10","Select","Select",""],["","69097052444","DICLOFENAC ","1%","200","Select","Select",""],["","00363045866","WAL-ZYR ","10MG","20","Select","Select",""],["","00067815203","VOLTAREN ","1%","200","Select","Select",""],["","10006070166","MELATONIN ","5MG","60","Select","Select",""],["","55111017915","TIZANIDINE ","2MG","120","Select","Select",""],["","00574060801","FERROUS ","324MG EC","30","Select","Select",""],["","00228277811","PROPRANOLOL ","60MG ER","30","Select","Select",""],["","68382050010","OMEPRAZOLE ","40MG","90","Select","Select",""],["","67877024901","QUETIAPINE ","50MG","60","Select","Select",""],["","00173059402","LAMICTAL ","START 49","49","Select","Select",""],["","29300012510","MELOXICAM ","15MG","30","Select","Select",""],["","50222026006","DOVONEX ","0.01%","60","Select","Select",""],["","16714078201","CLOBETASOL ","0.05%","15","Select","Select",""],["","63304069301","CLINDAMYCIN ","300MG","30","Select","Select",""],["","16714076301","CALCIPOTRIEN ","0.01%","60","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","28","Select","Select",""],["","00574110404","BROM\/PSE\/DM ","","120","Select","Select",""],["","65862020299","LOSARTAN ","50MG","30","Select","Select",""],["","51672127406","BETAMETH ","0.05%","45","Select","Select",""],["","00904759080","FEROSUL ","325MG","30","Select","Select",""],["","45802065087","LORATADINE ","10MG","30","Select","Select",""],["","45802065087","LORATADINE","10MG","30","Select","Select",""],["","00363193126","MILK","400\/5ML","769","Select","Select",""],["","29300011201","LAMOTRIGINE","100MG","60","Select","Select",""],["","00363040511","WAL-MUCIL","100%","660","Select","Select",""],["","00591252001","CHLORZOXAZON","500MG","90","Select","Select",""],["","00224180107","KONSYL","100%","450","Select","Select",""],["","65162062711","TRAMADOL","50MG","90","Select","Select",""],["","64380080807","IBUPROFEN","600MG","15","Select","Select",""],["","69238126601","OSELTAMIVIR","75MG","10","Select","Select",""],["","00054004641","IPRATROPIUM","0.06%","15","Select","Select",""],["","43598081115","CETIRIZINE","10MG","20","Select","Select",""],["","00781808926","AZITHROMYCIN","250MG","6","Select","Select",""],["","65162024709","CHLORTHALID","25MG","15","Select","Select",""],["","64380071206","BENZONATATE","100MG","15","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","16","Select","Select",""],["","00363045866","WAL-ZYR","10MG","20","Select","Select",""],["","61874013030","VRAYLAR","3MG","30","Select","Select",""],["","00173059402","LAMICTAL","START 49","49","Select","Select",""],["","67877024901","QUETIAPINE","50MG","60","Select","Select",""],["","80681004002","MELATONIN","5MG","60","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","28","Select","Select",""],["","16714078201","CLOBETASOL","0.05%","15","Select","Select",""],["","63304069301","CLINDAMYCIN","300MG","30","Select","Select",""],["","00574110404","BROM\/PSE\/DM","","120","Select","Select",""],["","00378875006","DICLOFENAC","1%","200","Select","Select",""],["","55111017915","TIZANIDINE","2MG","120","Select","Select",""],["","00067815203","VOLTAREN","1%","200","Select","Select",""],["","68382050010","OMEPRAZOLE","40MG","30","Select","Select",""],["","00574060801","FERROUS","324MG EC","30","Select","Select",""],["","65862020299","LOSARTAN","50MG","30","Select","Select",""],["","00228277811","PROPRANOLOL","60MG ER","30","Select","Select",""],["","29300012510","MELOXICAM","15MG","30","Select","Select",""],["","51672127406","BETAMETH","0.05%","45","Select","Select",""],["","50222026006","DOVONEX","0.01%","60","Select","Select",""],["","16714076301","CALCIPOTRIEN","0.01%","60","Select","Select",""],["","00904759080","FEROSUL","325MG","30","Select","Select",""],["","00005475571","CENTRUM ","TAB ULTRA","30","Select","Select",""],["","11917013870","FISH ","CAP 1000MG","60","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":""}]}]}