{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SYRA M MANGUS","gend":1,"add":"5635 ENGLISH SETTER CT","city":"RICHMOND","state":"VA","zip":"23237-9998","dob":"1977-07-25","age":"","mstatus":"","insh":"1293703*01","cliId":"","pno":8043172569,"cno":8043172569,"email":"","ename":"","eno":"","pphy":"FRENCH, KATRI NP","ppno":"","pcpadd":"12901 BRIGGS ROAD,","pcpcity":"CHESTER","pcpstate":"VA","pcpzip":"23831-9998","pcpcounty":"","pcpid":"","pcpname":"Bon Secours - Briggs Road Family Medicine","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I89.0","F41.1","F90.2","Z79.899","Z45.2","C50.919","M79.7","B00.9","C50.112","I36.1","Z90.12","Z85.3","Z42.1","V58.89","Z51.11","J45.40","Z51.12","Z17.0","Z01.419","T66.XXXA","L59.8","N65.0","C50.912","T85.79XA","E66.9","C50.911","Z98.82","Z80.3","NO DATA","Z20.822","R53.82","F41.0","K59.00","M62.838","Z79.51","Z15.01","Z90.721","Z92.21","Z91.048"],"date":["2021-03-09","2022-05-03","2022-02-10","2021-03-18","2021-03-31","2021-03-31","2022-05-03","2021-01-28","2022-01-20","2021-01-29","2022-05-03","2022-05-03","2022-05-03","2022-05-03","2021-01-29","2022-05-03","2021-03-18","2022-01-20","2022-02-03","2022-05-03","2021-07-07","2021-07-07","2021-07-07","2021-07-07","2022-02-15","2021-02-10","2021-02-10","2021-02-10","2022-05-03","2022-05-03","2022-05-03","2022-05-03","2022-05-03","2022-05-03","2022-05-03","2022-05-03","2022-05-03","2022-05-03","2022-05-03"],"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":[["","68180013501","ESCITALOPRAM","TAB 10MG","90","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","90","Select","Select",""],["","51862044630","TAMOXIFEN","TAB 20MG","30","Select","Select",""],["","62175031037","METHYLPHENID","TAB 18MG ER","30","Select","Select",""],["","31722077701","ACYCLOVIR","TAB 400MG","60","Select","Select",""],["","00093083205","CLONAZEPAM","TAB 0.5MG","4","Select","Select",""],["","53489012002","DOXYCYCL HYC","TAB 100MG","30","Select","Select",""],["","50458058501","CONCERTA","TAB 18MG","30","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","00173072020","FLOVENT HFA","AER 220MCG","12","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","00363106108","ANTISEPTIC","SOL SKIN CLN","474","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","67877032005","IBUPROFEN","TAB 600MG","21","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","57237023305","SMZ-TMP DS","TAB 800-160","14","Select","Select",""],["","00116200116","CHLORHEX GLU","SOL 0.0012","473","Select","Select",""],["","49483034010","ACETAMIN","TAB 325MG","84","Select","Select",""],["","00904679480","ASPIRIN LOW","CHW 81MG","30","Select","Select",""],["","49483008010","SENNA-TIME","TAB 8.6MG","14","Select","Select",""],["","00093216568","NALOXONE HCL","SPR ","2","Select","Select",""],["","67877022301","GABAPENTIN","CAP 300MG","18","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","10","Select","Select",""],["","42858000101","OXYCODONE","TAB 5MG","12","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","27808003502","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","30","Select","Select",""],["","00904699880","DOCUSATE SOD","CAP 100MG","14","Select","Select",""],["","31722077701","ACYCLOVIR TAB","400MG","60","Select","Select",""],["","31722095201","METHYLPHENID TAB","18MG ER","30","Select","Select",""],["","68180013501","ESCITALOPRAM TAB","10MG","90","Select","Select",""],["","00093083205","CLONAZEPAM TAB","0.5MG","4","Select","Select",""],["","00310737020","BUDES\/FORMOT AER","160-4.5","10","Select","Select",""],["","70010077001","METHOCARBAM TAB","750MG","90","Select","Select",""],["","00186037020","SYMBICORT AER","160-4.5","10","Select","Select",""],["","00363106108","ANTISEPTIC SOL SKIN CLN","","474","Select","Select",""],["","00116200116","CHLORHEX GLU SOL","0.12%","473","Select","Select",""],["","49483008010","SENNA-TIME TAB","8.6MG","14","Select","Select",""],["","00093216568","NALOXONE HCL SPR","","2","Select","Select",""],["","00904679480","ASPIRIN LOW CHW","81MG","90","Select","Select",""],["","49483034010","ACETAMIN TAB","325MG","84","Select","Select",""],["","65862042005","SMZ\/TMP DS TAB","800-160","10","Select","Select",""],["","00904699880","DOCUSATE SOD CAP","100MG","14","Select","Select",""],["","42858000101","OXYCODONE TAB","5MG","12","Select","Select",""],["","00093101042","MUPIROCIN OIN","2%","22","Select","Select",""],["","67877022301","GABAPENTIN CAP","300MG","18","Select","Select",""],["","67877032005","IBUPROFEN TAB","600MG","21","Select","Select",""],["","57237023305","SMZ-TMP DS TAB","800-160","14","Select","Select",""],["","00093314705","CEPHALEXIN CAP","500MG","28","Select","Select",""],["","27808003502","HYDROCO\/APAP TAB","5-325MG","12","Select","Select",""],["","00406051205","OXYCOD\/APAP TAB","5-325MG","30","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":""}]}]}