{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   AICIRTAPNILKNARF L","gend":1,"add":"AMLUK 3182B TPA LP N","city":"LYNCHBURG","state":"VA","zip":"24501-9998","dob":"1968-03-02","age":"","mstatus":"","insh":"57200210*91","cliId":"","pno":"57\/4071942-6","cno":"","email":"","ename":"","eno":"","pphy":"SPARACINO, HAILEY L DO","ppno":"434\/200-5200","pcpadd":"2323 MEMORIAL AVE STE 10","pcpcity":"LYNCHBURG","pcpstate":"VA","pcpzip":24501,"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":["M54.5","M54.16","M47.816","Z51.81","Z79.891","S91.331A","E78.5","G47.33","E11.51","E11.42","M79.671","M79.672","Z03.818","Z20.822","A59.9","N89.8","N95.0","J06.9","S20.212A","Z79.84","W10.8XXA","M25.519","M79.606","I73.9","NO DATA","E11.9","Z72.0","L29.9","I10.","J32.9","H60.92","G47.00","H66.92","T14.8XXA","M54.2","H25.13","L30.1","K52.9","F43.9","M51.36","G89.29","L20.84","M46.1","R07.89","J11.1","Z12.11","K57.30","M54.9","L81.9","M25.512","M79.605","V89.2XXA","S13.9XXA","R00.1","M25.511","M62.81","R35.0","B37.3","M75.41","M75.01","M62.838","I70.209","I70.208","M54.12","G47.9"],"date":["2021-07-28","2022-01-11","2022-01-11","2022-01-11","2022-02-25","2020-07-12","2020-10-16","2021-11-17","2020-10-16","2021-11-18","2021-11-18","2021-11-18","2021-08-19","2022-08-30","2020-01-07","2020-01-07","2020-02-12","2020-01-07","2020-10-16","2020-10-16","2020-10-16","2021-12-15","2021-08-30","2022-02-15","2022-01-11","2021-11-18","2021-05-19","2021-05-19","2022-06-10","2020-02-27","2020-02-27","2020-02-06","2020-02-18","2019-01-17","2022-05-11","2019-09-12","2019-06-19","2019-03-26","2019-09-03","2019-04-26","2019-04-26","2019-07-31","2019-12-11","2019-11-04","2019-02-11","2019-03-07","2019-03-07","2019-06-06","2019-10-22","2019-01-17","2019-01-17","2019-01-17","2019-01-21","2019-08-20","2022-06-30","2022-05-11","2022-06-10","2022-06-10","2022-02-25","2022-06-30","2022-01-13","2022-11-02","2022-03-08","2022-06-02","2022-05-10"],"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":[["","62332049141","TIZANIDINE","CAP 2MG","30","Select","Select",""],["","43386035701","HYDROCO\/APAP","TAB 7.5-325","90","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","43598086360","BUPROPION","TAB 150MG SR","180","Select","Select",""],["","59779060027","CVS","TAB 81MG EC","30","Select","Select",""],["","68180051303","LISINOPRIL","TAB 5MG","30","Select","Select",""],["","00093005805","TRAMADOL","TAB 50MG","150","Select","Select",""],["","","MELATONIN","TAB 3MG","","Select","Select",""],["","","NAPROXEN","TAB 500MG","","Select","Select",""],["","68382075810","METFORMIN","TAB 500MG","60","Select","Select",""],["","13668000705","ZOLPIDEM","TAB 5MG","30","Select","Select",""],["","49483048112","ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","51672128901","NYSTATIN","CRE 100000","15","Select","Select",""],["","","AMOXICILLIN","CAP 500MG","","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","64380071206","BENZONATATE","CAP 100MG","30","Select","Select",""],["","70377002911","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","00069046956","CHANTIX","TAB 1MG","56","Select","Select",""],["","53885024450","ONETOUCH","TES ULTRA BL","50","Select","Select",""],["","68462018135","CLOTRIMAZOLE","CRE 0.01","30","Select","Select",""],["","51991074890","DULOXETINE","CAP 60MG","30","Select","Select",""],["","00536340401","NICOTINE","GUM 2MG CINN","100","Select","Select",""],["","65862052405","GABAPENTIN","TAB 800MG","90","Select","Select",""],["","31124000003","BIOFREEZE","GEL 0.04","178","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","30","Select","Select",""],["","65862035790","CLOPIDOGREL","TAB 75MG","30","Select","Select",""],["","16729018201","HYDROCHLOROT","TAB 12.5MG","30","Select","Select",""],["","","CIPRO","SUS OTIC","","Select","Select",""],["","","AMOX\/K","TAB 875-125","","Select","Select",""],["","","NARCAN","SPR ","","Select","Select",""],["","","LIDOCAINE","PAD 0.05","","Select","Select",""],["","","FLUCLVX","INJ 2020-21","","Select","Select",""],["","59779054462","ARTHRTS","TAB 650MG","120","Select","Select",""],["","00093031101","LOPERAMIDE","CAP 2MG","12","Select","Select",""],["","65162052110","PROMETHAZINE","TAB 25MG","8","Select","Select",""],["","67253090050","ALPRAZOLAM","TAB 0.25MG","2","Select","Select",""],["","66993089749","AUG","OIN 0.0005","50","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","14","Select","Select",""],["","00832105410","BACLOFEN","TAB 10MG","50","Select","Select",""],["","43386009019","GAVILYTE-G","SOL ","4000","Select","Select",""],["","59779076678","PAIN","TAB 325MG","50","Select","Select",""],["","00603158758","PROMETH","SOL PLAIN","120","Select","Select",""],["","50111044101","TRAZODONE","TAB 150MG","90","Select","Select",""],["","49281041950","FLUZONE","INJ 2019-20","0","Select","Select",""],["","08463702930","LANCETS","MIS 30G","100","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":""}]}]}