{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   AICIRTAPNOSTREBOR B","gend":1,"add":"OB OP31 X","city":"PITTSVILLE","state":"VA","zip":"24139-9998","dob":"1965-06-16","age":"","mstatus":"","insh":"14300210*14","cliId":"","pno":"56\/4340892-6","cno":"","email":"","ename":"","eno":"","pphy":"SMITH, PAMELA MD","ppno":"434\/656-1274","pcpadd":"291 MCBRIDE LN","pcpcity":"GRETNA","pcpstate":"VA","pcpzip":24557,"pcpcounty":"","pcpid":"","pcpname":"CENTRA MEDICAL GROUP LLC","plan":"OHP","program":"MEDICAID","lob":"OHCC","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":["M20.42","M20.41","L60.0","B35.1","M79.674","M79.675","J34.89","J32.8","Z87.891","Z79.899","Z79.84","H53.8","J32.9","J31.0","G40.909","S93.401A","J45.909","I10.","E78.5","E11.9","E66.9","Z68.42","Z88.8","Z79.51","W01.0XXA","Y92.89","Z20.828","Z71.89","Z88.6","M25.562","Z20.822","K21.9","E66.01","R00.2","J34.2","D33.2","J34.1","Z91.81","M25.551","M65.871","Z23.","H05.011","J45.20","J11.1","R56.9","H25.13","H10.45","H31.093","H52.4","J18.9","F22.","J09.X2","R41.82","R00.0","F32.9","M25.561","NO DATA","Z68.41","M25.569","R79.89","E55.9","R05.","S83.421A","J06.9","T78.40XA","J30.9","M79.643","S83.421S","R26.2","M62.81","R06.02","R07.9","R06.00","Z71.3","E78.2","R63.4","R60.9","Q14.1","F33.0","F41.1","H61.20","M79.602","M79.89","R22.2","F32.5","K76.0","R60.0","Z12.11","Z86.010","D12.0","D12.3"],"date":["2022-04-08","2022-04-08","2022-04-08","2022-04-08","2022-04-08","2022-04-08","2021-03-10","2020-12-02","2022-05-06","2020-11-05","2021-03-10","2020-12-02","2021-03-10","2021-03-10","2022-04-19","2021-06-05","2021-06-05","2021-06-05","2021-06-05","2022-05-16","2021-06-05","2022-05-16","2021-06-05","2021-06-05","2021-06-05","2021-06-05","2020-11-05","2020-09-09","2020-09-09","2021-01-12","2021-03-05","2021-03-05","2022-08-16","2020-02-12","2020-06-09","2020-06-09","2020-06-09","2021-05-24","2021-05-24","2021-06-16","2021-11-10","2020-02-20","2020-02-21","2020-02-21","2020-02-19","2021-10-21","2021-10-21","2021-10-21","2021-10-21","2020-02-19","2020-02-19","2020-02-19","2020-02-19","2020-02-19","2020-04-23","2021-08-27","2021-10-21","2019-10-21","2019-10-21","2019-10-21","2019-10-21","2019-04-13","2019-07-31","2019-08-13","2019-08-13","2019-08-13","2019-10-08","2019-08-29","2019-07-10","2019-07-10","2019-09-10","2019-09-10","2019-09-10","2019-02-12","2019-04-19","2019-04-19","2019-07-08","2019-10-21","2019-01-15","2019-01-15","2019-01-29","2022-05-16","2022-05-06","2022-05-06","2022-05-16","2022-08-16","2022-05-06","2022-11-03","2022-11-03","2022-11-03","2022-11-03"],"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":{"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":[["","00904759060","FEROSUL","TAB 325MG","30","Select","Select",""],["","68462013701","OXCARBAZEPIN","TAB 150MG","60","Select","Select",""],["","16729011917","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","71093013205","METFORMIN","TAB 500MG","60","Select","Select",""],["","65862001305","SERTRALINE","TAB 100MG","30","Select","Select",""],["","55111015905","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","16729004417","ATORVASTATIN","TAB 10MG","30","Select","Select",""],["","31722053960","LEVETIRACETA","TAB 1000MG","90","Select","Select",""],["","67877019910","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","00832532511","POT  CL MICRO","TAB 20MEQ ER","60","Select","Select",""],["","16729029901","TRAZODONE","TAB 50MG","30","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00904674880","BISACODYL","TAB 5MG EC","2","Select","Select",""],["","","POLYETH","POW 3350 NF","","Select","Select",""],["","","LORATADINE","TAB 10MG","","Select","Select",""],["","74312017621","D3","CAP 50MCG","150","Select","Select",""],["","29300012501","MELOXICAM","TAB 15MG","30","Select","Select",""],["","80777027310","MODERNA","INJ COVID-19","0","Select","Select",""],["","67877021901","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","57237023305","SMZ-TMP","TAB 800-160","14","Select","Select",""],["","69230020201","ALLERGY","TAB 180MG","30","Select","Select",""],["","","DOXYCYCL","CAP 100MG","","Select","Select",""],["","","OSELTAMIVIR","CAP 75MG","","Select","Select",""],["","","OXYCODONE","TAB 5MG","","Select","Select",""],["","","12HOUR","SPR 0.0005","","Select","Select",""],["","","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","","FLUTIC\/SALME","AER 250\/50","","Select","Select",""],["","","MUPIROCIN","OIN 0.02","","Select","Select",""],["","","BUDESONIDE","SUS 0.5MG\/2","","Select","Select",""],["","","CIPROFLOXACN","TAB 500MG","","Select","Select",""],["","43547035311","LISINOPRIL","TAB 10MG","30","Select","Select",""],["","63824000815","MUCINEX","TAB 600MG ER","20","Select","Select",""],["","00173069600","ADVAIR","AER 250\/50","60","Select","Select",""],["","60505083001","MOMETASONE","SPR 50MCG","17","Select","Select",""],["","65862064163","AZITHROMYCIN","TAB 250MG","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}