{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NREVELHTIMS ","gend":1,"add":"SRAM 062TS LLAH","city":"DRAKES BRANCH","state":"VA","zip":23937,"dob":"1973-05-15","age":"","mstatus":"","insh":"2725110*83","cliId":"","pno":"02\/4340468-8","cno":"","email":"","ename":"","eno":"","pphy":"Route,  barbara","ppno":"434\/542-5560","pcpadd":"5424 Discovery Park Blvd BLDB A STE 201","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23937,"pcpcounty":"","pcpid":"","pcpname":"CENTRAL VIRGINIA HEALTH SERVICES INC","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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M50.30","M54.2","M62.81","R29.3","M25.512","M54.12","M47.812","E11.9","Z01.419","Z20.2","Z12.31","G47.33","M25.522","M25.622","M25.532","M62.838","M77.8","M77.12","G56.22","M79.602","Z47.89","M48.02","M50.20","H61.20","T16.9XXA","G56.02","G56.03","G89.4","NO DATA","G47.30","R06.83","G47.10","M51.36","M54.5","M54.16","H66.92","S60.411A","M47.12","X58.XXXA","B02.9","R79.89","S69.92XA","R29.2","F43.23","E66.3","M50.322","M50.323","M43.02","F43.0","J30.2","E66.9","Z68.32","Z79.84","G56.42","M79.642","Z98.890","F41.1","M19.042","M25.561","L03.116","R22.42","M79.662","I10.","M41.9","R49.0"],"date":["2021-07-12","2021-07-12","2022-05-12","2020-08-27","2022-05-12","2022-11-03","2021-04-27","2022-11-03","2021-06-17","2021-06-17","2021-06-17","2022-11-03","2022-05-03","2022-02-17","2019-01-05","2020-09-28","2021-07-29","2022-05-23","2022-05-23","2022-02-17","2022-02-24","2021-05-13","2021-07-12","2021-07-15","2021-07-15","2022-05-23","2021-10-14","2019-06-25","2022-11-03","2019-07-27","2019-07-27","2019-07-27","2020-08-05","2020-08-05","2021-07-12","2021-07-13","2019-01-28","2019-02-11","2019-01-05","2020-02-13","2020-02-13","2019-02-13","2019-01-21","2019-01-21","2020-01-02","2019-05-16","2019-05-16","2019-05-16","2019-05-16","2019-07-15","2019-07-15","2019-07-15","2021-11-01","2022-03-24","2022-05-23","2022-03-24","2022-10-31","2022-05-23","2022-03-24","2022-06-25","2022-06-25","2022-06-25","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":[["","69238131109","PREGABALIN","CAP 50MG","60","Select","Select",""],["","80777027310","MODERNA","INJ COVID-19","0","Select","Select",""],["","57664050318","TIZANIDINE","TAB 4MG","60","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","30","Select","Select",""],["","65162027250","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","20","Select","Select",""],["","65862001305","SERTRALINE","TAB 100MG","30","Select","Select",""],["","23155050110","HYDROXYZ","TAB 25MG","60","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","60","Select","Select",""],["","69097082312","CITALOPRAM","TAB 20MG","30","Select","Select",""],["","31722053401","METHOCARBAM","TAB 750MG","20","Select","Select",""],["","00093005805","TRAMADOL","TAB 50MG","14","Select","Select",""],["","23155065205","METRONIDAZOL","TAB 500MG","4","Select","Select",""],["","43598032675","CIPRO\/DEXA","SUS 0.3-0.1%","8","Select","Select",""],["","68645054859","METFORMIN","TAB 850MG","90","Select","Select",""],["","67877022305","GABAPENTIN","CAP 300MG","81","Select","Select",""],["","68645057454","GLIPIZIDE","TAB 5MG","30","Select","Select",""],["","00093227534","AMOX\/K","TAB 875-125","20","Select","Select",""],["","61442010310","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","00603533815","PREDNISONE","PAK 10MG","21","Select","Select",""],["","69097084615","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","","VALACYCLOVIR","TAB 1GM","","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","7","Select","Select",""],["","00591367001","NABUMETONE","TAB 500MG","60","Select","Select",""],["","69097015907","MELOXICAM","TAB 15MG","30","Select","Select",""],["","","CELECOXIB","CAP 200MG","","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":""}]}]}