{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TERAGRAMTEERTS ","gend":1,"add":"      DR NOTLAW KAAZI 496                         ","city":"AMHERST                  ","state":"VA","zip":"24521-9998","dob":"1984-07-12","age":"","mstatus":"","insh":"00116767","cliId":"","pno":"4843411325","cno":4348452806,"email":"","ename":"","eno":"","pphy":"DERAMO, CHRISTOPHER C","ppno":4349469565,"pcpadd":"115 AMBRIAR PLZ,","pcpcity":"Amherst","pcpstate":"VA","pcpzip":245214741,"pcpcounty":"","pcpid":"","pcpname":"CENTRA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"694 IZAAK WALTON RD                               ","madd2":"                                                  ","madd3":"","mcity":"AMHERST                  ","mstate":"VA","mzip":"24521-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N94.6","S83.005A","Z30.017","Z32.02","Z01.419","Z00.00","F41.9","F79","G47.00","S82.002A","S80.02XA","F70","R09.02","R52","R11.0","Z23","Z76.89","N92.6","S72.422A","Z86.73","S82.092A","Z30.42","S83.015A","M79.603","M25.562","S89.82XA","W18.39XA","Y93.89","M75.81","M25.511","S82.092D","S42.254K","R22.0","R53.83","E78.5","R79.89","T14.8XXA"," "],"date":["2020-02-03","2020-03-04","2020-05-29","2020-05-29","2019-11-12","2020-03-09","2022-08-24","2022-07-21","2020-09-01","2019-10-17","2019-10-17","2021-08-06","2019-10-16","2019-10-16","2019-10-16","2019-11-12","2022-07-21","2020-03-09","2019-10-16","2019-10-16","2019-10-17","2020-04-28","2019-10-16","2019-10-28","2019-11-19","2019-10-16","2019-10-16","2019-10-16","2019-10-28","2019-10-28","2019-11-19","2019-11-19","2022-08-11","2022-07-21","2022-08-24","2022-07-21","2022-08-03","2022-08-24"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","51991074890","DULOXETINE","CAP 60MG","90","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","00703680101","MEDROXYPR","INJ 150MG\/ML","1","Select","Select",""],["","49281042150","FLUZONE","INJ 2021-22","0.5","Select","Select",""],["","50111043301","TRAZODONE","TAB 50MG","90","Select","Select",""],["","16714008210","HYDROXYZ","TAB 25MG","30","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","30","Select","Select",""],["","43598075205","BUPROPION","TAB 150MG SR","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":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"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":""}]}]}