{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  NAUJ'ANNNYWG M ","gend":0,"add":"RATS 723RD TNOM","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"1999-10-16","age":"","mstatus":"","insh":"38200210*88","cliId":"","pno":"24\/4343476-5","cno":"","email":"","ename":"","eno":"","pphy":"ALBA, GREGORY DO","ppno":"434\/791-2273","pcpadd":"414 PARK AVENUE","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"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":["F33.1","M54.5","M54.6","NO DATA","H10.413","M25.571","M54.16","E66.3","L02.91","L70.0","L91.0","H10.012","L73.2","I10.","E66.01","L81.4","L85.3","R20.8","R07.89","R52.","G44.89","Z79.899","R51.","K21.9","R45.89","M76.821","M21.40","R58.","L53.8","H10.32","J06.9","H10.022","L72.0","G47.30","J30.1","J35.1","Z91.81","J02.9","J30.2","Z20.828"],"date":["2019-06-29","2021-01-15","2020-05-20","2020-03-17","2020-03-17","2021-01-15","2021-01-15","2020-09-16","2021-02-04","2021-05-17","2021-12-16","2019-11-13","2021-12-16","2021-11-03","2021-11-03","2021-07-15","2021-09-16","2021-12-16","2020-02-16","2021-01-27","2021-01-27","2021-02-05","2019-01-13","2019-01-13","2021-04-21","2021-06-08","2021-06-08","2021-12-16","2021-12-16","2019-11-02","2019-11-02","2019-11-04","2021-05-17","2021-11-03","2021-11-03","2021-11-03","2021-11-03","2021-04-14","2021-04-14","2021-11-08"],"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":[["","","HUMIRA","KIT CD\/UC\/HS","","Select","Select",""],["","","DICLOFENAC","TAB 75MG DR","","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","44","Select","Select",""],["","68180031909","BUPROPN","TAB 150MG XL","30","Select","Select",""],["","","HYDROXYZ","CAP 50MG","","Select","Select",""],["","","MINOCYCLINE"," MINOCYCLINE ","30","Select","Select",""],["","68180051802","LISINOP\/HCTZ","TAB 10-12.5","30","Select","Select",""],["","51672130100","AMMONIUM","CRE 0.12","385","Select","Select",""],["","","CLINDAMYCIN"," CLINDAMYCIN ","60","Select","Select",""],["","65862037401","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","","PROPRANOLOL","TAB 80MG","","Select","Select",""],["","00234057532","HIBICLENS","LIQ 0.04","7568","Select","Select",""],["","29300046810","CLONIDINE","TAB 0.1MG","30","Select","Select",""],["","00234058717","HIBISTAT","MIS 0.005","100","Select","Select",""],["","65162027250","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","00187516045","RETIN-A","CRE 0.00025","45","Select","Select",""],["","","ETODOLAC","TAB 400MG","","Select","Select",""],["","","LISINOPRIL","TAB 20MG","","Select","Select",""],["","","CROMOLYN","SOL 4% OP","","Select","Select",""],["","","AMOXICILLIN","TAB 500MG","","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":""}]}]}