{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KEITH  D LUNSFORD","gend":0,"add":"6060 JEFFERSON AVE","city":"NEWPORT NEWS","state":"VA","zip":"23605-9998","dob":"1965-05-19","age":"","mstatus":"","insh":"20075407*01","cliId":"","pno":7579151430,"cno":7579151430,"email":"","ename":"","eno":"","pphy":"HOLTZ, KRISTEN E DO","ppno":7578271940,"pcpadd":"3401 W MERCURY BLVD,","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":"23666-9998","pcpcounty":"","pcpid":"","pcpname":"Riverside Primary Care Mercury West","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7575964715,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R55.","R42.","R07.9","N45.1","R03.0","F14.20","F10.20","I10.","R35.1","Z12.5","H53.9","Z11.59","Z13.220","Z83.3","I51.7","R94.31","F17.210","R06.02","F17.200","Z72.0","N40.1","N52.9","R39.12","R39.14","R39.15","R35.0","Z02.2","F33.1","F10.21","F43.29","N43.3","R07.89","F14.10","F10.10","F10.239","F20.5","H54.40","Z20.822","Z88.6","Z88.8","Z91.199","Z81.1","Z82.49","F12.20"],"date":["2021-06-10","2021-05-22","2022-10-02","2022-05-08","2022-05-08","2023-07-18","2023-07-18","2023-06-16","2023-01-10","2023-01-10","2023-01-10","2023-01-10","2023-01-10","2023-01-10","2021-06-02","2021-06-02","2022-10-03","2021-06-29","2023-07-18","2021-06-29","2023-06-16","2021-06-16","2021-06-16","2021-06-16","2021-06-16","2023-06-16","2023-06-16","2021-06-23","2021-06-23","2021-06-23","2022-05-08","2022-10-02","2022-10-02","2022-10-02","2022-10-03","2022-10-03","2022-10-03","2022-10-03","2022-10-03","2022-10-03","2022-10-03","2022-10-03","2022-10-03","2023-07-18"],"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":[["","68180072103","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","76282025190","ESCITALOPRAM","TAB 20MG","30","Select","Select",""],["","47781060730","DISULFIRAM","TAB 250MG","28","Select","Select",""],["","68462012605","GABAPENTIN","600 MG","60","Select","Select",""],["","16571071901","QUETIAPINE","TAB 100MG","30","Select","Select",""],["","68382013201","TAMSULOSIN","CAP 0.4MG","7","Select","Select",""],["","52817018000","CLONIDINE","TAB 0.1MG","1","Select","Select",""],["","00002446330","CIALIS","TAB 10MG","7","Select","Select",""],["","65862018730","ONDANSETRON","TAB 4MG","10","Select","Select",""],["","64380080907","IBUPROFEN","400 MG","30","Select","Select",""],["","24385047847","ANTACID","CHW 500MG","40","Select","Select",""],["","00527058610","DICYCLOMINE","CAP 10MG","10","Select","Select",""],["","00115180301","HYDROXYZ PAM","CAP 25MG","15","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","68462016205","CARVEDILOL","TAB 3.125MG","7","Select","Select",""],["","23155053006","TROSPIUM CL","TAB 20MG","30","Select","Select",""],["","31722064530","TADALAFIL","TAB 10MG","7","Select","Select",""],["","13668033005","TRAZODONE","TAB 50MG","14","Select","Select",""],["","42799060501","LOPERAMIDE","CAP 2MG","10","Select","Select",""],["","67877019910","AMLODIPINE BESYLATE","10 MG","30","Select","Select",""],["","65862059801","TAMSULOSIN HCL","0.4 MG","30","Select","Select",""],["","16729010912","QUETIAPINE FUMARATE ER","150 MG","30","Select","Select",""],["","16729016901","ESCITALOPRAM OXALATE","10 MG","60","Select","Select",""],["","00054074287","ALBUTEROL SULFATE HFA","90 MCG","6.7","Select","Select",""],["","13668033005","TRAZODONE TAB","50MG","14","Select","Select",""],["","24385047847","ANTACID CHW","500MG","40","Select","Select",""],["","69097094312","GABAPENTIN CAP","300MG","10","Select","Select",""],["","67877019990","AMLODIPINE TAB","10MG","30","Select","Select",""],["","23155053006","TROSPIUM CL TAB","20MG","30","Select","Select",""],["","67877025001","QUETIAPINE TAB","100MG","30","Select","Select",""],["","31722064530","TADALAFIL TAB","10MG","7","Select","Select",""],["","00002446330","CIALIS TAB","10MG","7","Select","Select",""],["","65862018730","ONDANSETRON TAB","4MG","10","Select","Select",""],["","68462016205","CARVEDILOL TAB","3.125MG","7","Select","Select",""],["","68382013201","TAMSULOSIN CAP","0.4MG","7","Select","Select",""],["","52817018000","CLONIDINE TAB","0.1MG","20","Select","Select",""],["","42799060501","LOPERAMIDE CAP","2MG","10","Select","Select",""],["","68180096301","ALBUTEROL AER HFA","","8","Select","Select",""],["","00527058610","DICYCLOMINE CAP","10MG","10","Select","Select",""],["","00115180301","HYDROXYZ PAM CAP","25MG","15","Select","Select",""],["","59651036005","IBUPROFEN TAB","400MG","30","Select","Select",""],["","68001023703","CLONIDINE HCL","0.1 MG","90","Select","Select",""],["","46122035374","NICOTINE PATCH","21 MG\/24HR","28","Select","Select",""],["","00536132701","ACETAMINOPHEN","325 MG","60","Select","Select",""],["","45802081184","NALOXONE HCL","4 MG","2","Select","Select",""],["","74312007901","MELATONIN","3 MG","30","Select","Select",""],["","65862018730","ONDANSETRON HCL","4 MG","10","Select","Select",""],["","69097052444","DICLOFENAC SODIUM","1 %","100","Select","Select",""],["","13668033005","TRAZODONE HCL","50 MG","7","Select","Select",""],["","00185067405","HYDROXYZINE PAMOATE","25 MG","15","Select","Select",""],["","42806016005","HYDROXYZINE HCL","25 MG","30","Select","Select",""],["","16729034810","LURASIDONE HCL","60 MG","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":""}]}]}