{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   YNAFFITRUOBRAB D","gend":1,"add":"ETTAP 9301DAOR NOSR","city":"RUSTBURG","state":"VA","zip":"24588-9998","dob":"1978-11-29","age":"","mstatus":"","insh":"0465110*94","cliId":"","pno":"52\/4343553-8","cno":"","email":"","ename":"","eno":"","pphy":"FRAZIER, DONNA E NP","ppno":"434\/200-4175","pcpadd":"1330 OAK LANE STE 202","pcpcity":"LYNCHBURG","pcpstate":"VA","pcpzip":24503,"pcpcounty":"","pcpid":"","pcpname":"CENTRA MEDICAL GROUP LLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R11.2","R09.82","K58.9","Z71.9","G57.02","M70.72","G56.01","G56.21","K50.90","M79.671","M79.672","M20.12","G57.62","R31.9","M20.22","G89.18","L40.0","M62.81","M54.16","M47.816","M51.36","M54.5","M79.7","F41.1","F33.1","N81.11","S83.412A","D25.1","J32.8","R13.19","K21.9","H90.A21","J38.2","H93.A1","Z87.19","H90.41","R11.0","R42.","R35.0","R80.1","N18.2","L68.0","L73.2","R39.9","F32.9","G89.29","NO DATA","K11.20","N92.1","N92.5","N39.3","M65.321","J06.9","Z20.828","L20.84","R05.","G43.909","F12.20","M70.62","L40.8","Z79.899","M25.50","K50.919","M25.552","F41.9","R25.2","E55.9","M13.80","G89.4","Z11.59","M54.6","N94.6","Z51.81","F11.90","H93.8X3","M75.82","M54.10","R10.30","F43.10","Z71.89","Z71.3","K59.00","Z87.891","Z88.5","R10.84","M54.2","M75.42","M54.12","F17.210","R10.2","L81.0","R10.32","N83.202","G56.23","G56.03","R07.89","M25.512"],"date":["2021-09-27","2021-01-07","2021-09-27","2021-09-27","2021-08-06","2021-08-06","2020-02-24","2020-02-24","2021-12-17","2021-10-01","2021-10-01","2021-10-01","2021-10-01","2020-06-29","2020-11-18","2020-07-23","2020-09-09","2020-10-21","2021-05-27","2021-04-22","2021-04-22","2021-09-13","2021-12-17","2021-06-22","2021-06-22","2021-07-12","2021-10-26","2021-11-12","2021-11-24","2021-11-24","2021-11-24","2021-11-24","2021-11-24","2021-11-24","2021-11-24","2021-11-24","2021-01-07","2021-01-07","2021-09-09","2021-09-09","2021-09-09","2020-09-09","2021-09-10","2020-10-30","2020-10-30","2021-05-04","2021-12-17","2021-03-16","2021-07-12","2021-06-07","2021-11-12","2021-01-26","2021-02-10","2021-02-10","2021-09-10","2020-04-22","2021-12-17","2021-12-17","2020-06-12","2020-06-12","2020-06-12","2020-06-12","2020-06-12","2020-06-29","2021-03-03","2021-03-03","2021-03-03","2021-09-27","2020-02-05","2020-07-16","2021-04-22","2021-06-18","2021-07-15","2021-07-15","2021-10-01","2019-02-01","2019-06-06","2019-04-26","2019-04-26","2019-07-26","2019-07-26","2019-06-08","2019-06-08","2019-06-08","2019-02-05","2019-04-18","2019-04-18","2019-04-18","2019-08-28","2019-09-06","2019-03-28","2019-02-20","2019-02-20","2019-08-30","2019-08-30","2019-04-08","2019-04-08"],"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":{"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":[["","00456120230","LINZESS","CAP 290MCG","30","Select","Select",""],["","55111015905","OMEPRAZOLE","CAP 40MG","60","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","30","Select","Select",""],["","","HALOBETASOL","OIN 0.0005","","Select","Select",""],["","","TRAMADOL","TAB 50MG","","Select","Select",""],["","","MIRALAX","POW 3350 NF","","Select","Select",""],["","60432060816","PROMETHAZINE","SYP 6.25\/5ML","200","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","180","Select","Select",""],["","53489011905","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","51991074710","DULOXETINE","CAP 30MG","60","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","20","Select","Select",""],["","10702001150","HYDROXYZ","TAB 25MG","30","Select","Select",""],["","","BACLOFEN","TAB 10MG","","Select","Select",""],["","","SMZ\/TMP","TAB 800-160","","Select","Select",""],["","51991081403","AZELASTINE","SPR 0.001","30","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","14","Select","Select",""],["","66993087761","CALCIPOTRIEN","CRE 0.00005","120","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","","POLYETH","POW 3350 NF","","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","42","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","00234057508","HIBICLENS","LIQ 0.04","236","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","20","Select","Select",""],["","49884093547","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","00555077902","MEDROXYPR","TAB 10MG","60","Select","Select",""],["","43386009662","CLOBETASOL","OIN 0.0005","60","Select","Select",""],["","49483060350","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","00555088602","ESTRADIOL","TAB 1MG","90","Select","Select",""],["","00713050324","ANUCORT-HC","SUP 25MG","12","Select","Select",""],["","53191036212","VITAMIN","CAP 50000UNT","8","Select","Select",""],["","62559043130","HYDROCORTISO","CRE 0.025","60","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","30","Select","Select",""],["","69230020201","ALLERGY","TAB 180MG","30","Select","Select",""],["","","NARATRIPTAN","TAB 2.5MG","","Select","Select",""],["","","PROPRANOLOL","CAP 60MG ER","","Select","Select",""],["","","ONDANSETRON","TAB 8MG ODT","","Select","Select",""],["","50742018921","METHYLPRED","TAB 4MG","21","Select","Select",""],["","55111029209","SUMATRIPTAN","TAB 50MG","9","Select","Select",""],["","","AMOX\/K","TAB 875-125","","Select","Select",""],["","57894006003","STELARA","INJ 45MG\/0.5","0","Select","Select",""],["","","BENZONATATE","CAP 100MG","","Select","Select",""],["","","FEXOFENADINE","TAB 180MG","","Select","Select",""],["","65862019399","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","","VANIQA","CRE 0.139","","Select","Select",""],["","00168020260","CLINDAMYCIN","GEL 0.01","60","Select","Select",""],["","","DOCUSATE","CAP 100MG","","Select","Select",""],["","","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","","SPIRONOLACT","TAB 25MG","","Select","Select",""],["","","AMMONIUM","LOT 0.12","","Select","Select",""],["","59779030603","CVS","POW ","510","Select","Select",""],["","","PROAIR","AER ","","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","68180065208","DOXYCYC","CAP 100MG","30","Select","Select",""],["","00168005615","BETAMETH","OIN 0.0005","15","Select","Select",""],["","00172392570","DIAZEPAM","TAB 2MG","60","Select","Select",""],["","60505025203","TIZANIDINE","TAB 4MG","135","Select","Select",""],["","63481068447","VOLTAREN","GEL 0.01","100","Select","Select",""],["","61703035038","METHOTREXATE","INJ 25MG\/ML","4","Select","Select",""],["","00143312601","DICYCLOMINE","CAP 10MG","28","Select","Select",""],["","25021067376","GLYDO","GEL 0.02","60","Select","Select",""],["","31722070430","VALACYCLOVIR","TAB 500MG","6","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":""}]}]}