{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" N   ASILSTTEKCIR","gend":1,"add":"NARG 721STC NID","city":"DANVILLE","state":"VA","zip":"24541-9998","dob":"1985-01-26","age":"","mstatus":"","insh":"3926110*60","cliId":"","pno":"77\/4341537-0","cno":"","email":"","ename":"","eno":"","pphy":"PRUITT, RACHEL PA","ppno":"434\/200-3908","pcpadd":"125 NATIONWIDE DRIVE","pcpcity":"LYNCHBURG","pcpstate":"VA","pcpzip":24502,"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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R07.9","R06.02","F33.0","F50.89","K21.9","E66.01","Z68.42","Z71.3","Z68.41","E11.9","I10.","Z01.419","E66.3","Z71.9","Z88.7","N92.6","N94.10","F41.9","F32.9","M51.36","E66.9","Z68.30","L98.7","E65.","L30.4","Z98.84","J18.9","R05.","R51.","L50.0","E78.00","Z88.2","Z88.8","Z88.3","Z91.010","R21.","G47.30","Z00.00","Z23.","E78.5","M19.90","G25.81","R19.7","Z79.84","K91.840","G47.33","S13.9XXA","S33.8XXA","M41.9","D31.32","H52.13","R42.","J32.9","R51.9","M54.2","M54.9","R79.0","M54.5","F41.8","G89.29","Z68.31","E11.65","J30.1","R12.","K31.89","D64.9","Z68.34","K29.70","I95.9","R00.0","Z83.3","Z82.49","Z80.3","Z68.37","NO DATA","E61.1","Z68.32","Z68.29","K91.2","G43.909","K92.2","R55.","K51.50"],"date":["2019-05-02","2019-05-02","2019-07-09","2019-07-09","2021-11-03","2020-02-05","2019-08-21","2020-02-05","2019-11-11","2021-11-03","2021-11-03","2020-06-15","2020-11-12","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2021-04-01","2021-11-03","2021-09-16","2021-11-03","2021-06-03","2021-11-19","2021-11-19","2021-06-28","2021-11-03","2021-08-07","2021-08-07","2019-05-15","2019-05-22","2019-06-10","2019-05-22","2019-05-22","2019-05-22","2019-05-22","2019-05-22","2019-08-01","2019-08-15","2019-08-15","2021-11-03","2021-11-03","2021-09-16","2019-05-10","2019-05-17","2019-11-11","2019-11-11","2020-05-05","2020-05-05","2020-05-05","2021-07-21","2021-07-21","2021-07-31","2021-07-31","2021-07-31","2021-07-31","2021-07-31","2019-08-01","2020-06-12","2021-09-16","2021-09-16","2021-11-03","2019-05-05","2019-05-23","2019-08-28","2019-08-28","2020-01-17","2020-01-17","2019-09-26","2019-11-11","2019-11-11","2019-11-11","2019-11-11","2019-11-11","2019-11-27","2020-01-06","2020-02-24","2020-02-24","2020-11-12","2020-11-12","2019-05-17","2019-11-14","2019-11-14","2019-05-12"],"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":[["","","JANUVIA"," JANUVIA ","30","Select","Select",""],["","","DICLOFENAC"," DICLOFENAC ","60","Select","Select",""],["","","BUPROPION"," BUPROPION ","30","Select","Select",""],["","","SUMATRIPTAN"," SUMATRIPTAN ","2","Select","Select",""],["","","SUPRAX"," SUPRAX ","10","Select","Select",""],["","","GLIMEPIRIDE"," GLIMEPIRIDE ","30","Select","Select",""],["","","PREDNISONE"," PREDNISONE ","10","Select","Select",""],["","","HYDROCHLOROT"," HYDROCHLOROT ","30","Select","Select",""],["","","NITROFURANTN"," NITROFURANTN ","14","Select","Select",""],["","","METFORMIN"," METFORMIN ","60","Select","Select",""],["","","LOSARTAN"," LOSARTAN ","30","Select","Select",""],["","","TIZANIDINE"," TIZANIDINE ","90","Select","Select",""],["","","DIPHEN\/ATROP"," DIPHEN\/ATROP ","24","Select","Select",""],["","","GABAPENTIN"," GABAPENTIN ","30","Select","Select",""],["","","RECLIPSEN"," RECLIPSEN ","28","Select","Select",""],["","","METRONIDAZOL"," METRONIDAZOL ","30","Select","Select",""],["","","ONDANSETRON"," ONDANSETRON ","12","Select","Select",""],["","","CIPROFLOXACN"," CIPROFLOXACN ","20","Select","Select",""],["","","ATORVASTATIN"," ATORVASTATIN ","30","Select","Select",""],["","","CYCLOBENZAPR"," CYCLOBENZAPR ","30","Select","Select",""],["","","HYDROCO\/APAP"," HYDROCO\/APAP ","10","Select","Select",""],["","","AZITHROMYCIN"," AZITHROMYCIN ","7","Select","Select",""],["","","CEFIXIME"," CEFIXIME ","10","Select","Select",""],["","","ALPRAZOLAM"," ALPRAZOLAM ","30","Select","Select",""],["","","DESO\/ETHINYL"," DESO\/ETHINYL ","28","Select","Select",""],["","","IRON"," IRON ","30","Select","Select",""],["","","SE-TAN"," SE-TAN ","30","Select","Select",""],["","","OMEPRAZOLE"," OMEPRAZOLE ","90","Select","Select",""],["","","DOCUSATE"," DOCUSATE ","60","Select","Select",""],["","","JUNEL","TAB 43831","","Select","Select",""],["","","LEVOCETIRIZI","TAB 5MG","","Select","Select",""],["","","FERROUS","TAB 324MG","","Select","Select",""],["","","DICLOFEN","TAB 50MG","","Select","Select",""],["","","ISIBLOOM","TAB 0.15-30","","Select","Select",""],["","65162052111",""," ","60","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","65162062750","TRAMADOL","TAB 50MG","30","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","30","Select","Select",""],["","68180012101","CEPHALEXIN","CAP 250MG","28","Select","Select",""],["","59746012106","MECLIZINE","TAB 25MG","30","Select","Select",""],["","57237009960","CEFDINIR","CAP 300MG","10","Select","Select",""],["","00781185220","AMOX\/K","TAB 875-125","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":{"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":""}]}]}