{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   REMLENNIUG L","gend":0,"add":"NIL 411NL NLOC","city":"STAUNTON","state":"VA","zip":"24401-9998","dob":"1970-01-22","age":"","mstatus":"","insh":"2513210*76","cliId":"","pno":"52\/0458338-5","cno":"540\/255-8338","email":"","ename":"","eno":"","pphy":"CHERNOFF, DAVID B MD","ppno":"540\/885-3525","pcpadd":"STAUNTON MED CTR 40 LAMBERT ST STE5","pcpcity":"STAUNTON","pcpstate":"VA","pcpzip":24401,"pcpcounty":"","pcpid":"","pcpname":"Carilion Family Medicine Staunton","plan":"OHP","program":"MEDICAID","lob":"M4","region":"WESTERN\/ CHARLOTTESVILLE","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":["F43.12","F39.","F60.3","M54.5","G89.4","N45.1","K76.0","G89.29","Z11.59","M67.922","Z01.810","Z01.812","M54.2","M79.603","F41.8","NO DATA","M51.36","M43.17","M54.17","M79.604","M79.605","R26.89","M79.601","M79.602","M19.90","Z86.69","Z87.828","Z87.820","M47.22","M50.10","R06.00","Z98.1","R07.89","F43.23","M25.522","M54.16","M54.12","F33.2","G40.409","Y33.XXXS","F43.10","Z01.818","M50.123","E66.9","R56.9","Y33.XXXA","M54.40","N43.41","N50.9","N43.40"],"date":["2022-09-09","2021-11-22","2021-11-22","2021-03-11","2020-08-26","2020-08-26","2020-08-26","2020-11-17","2020-09-10","2021-05-04","2021-04-22","2021-04-22","2021-04-22","2021-04-22","2021-07-19","2022-02-09","2022-02-09","2022-02-09","2022-02-09","2020-11-17","2020-11-17","2020-11-17","2020-11-17","2020-11-17","2020-11-17","2020-11-17","2020-11-17","2020-11-17","2021-03-11","2021-05-14","2022-01-25","2022-01-25","2022-01-25","2020-09-22","2020-12-30","2020-12-30","2020-12-30","2020-11-19","2020-12-22","2020-12-22","2021-03-15","2021-04-22","2021-04-22","2021-04-22","2021-04-22","2020-10-22","2020-10-22","2020-08-28","2020-08-28","2020-09-14"],"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":[["","13668013601","ESCITALOPRAM","TAB 10MG","90","Select","Select",""],["","42806016005","HYDROXYZ","TAB 25MG","180","Select","Select",""],["","43547034206","RISPERIDONE","TAB 2MG","90","Select","Select",""],["","00832105410","BACLOFEN","TAB 10MG","90","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","21","Select","Select",""],["","65862022701","LAMOTRIGINE","TAB 25MG","120","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","270","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","15","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","42","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","24658031205","DOXYCYCL","TAB 100MG","28","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","14","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":""}]}]}