{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  TERAGRAMOCEHCAP O ","gend":1,"add":"ECNIRP 21472YWH DRAWDE ","city":"RICE","state":"VA","zip":"23966-9998","dob":"1985-11-20","age":"","mstatus":"","insh":"5811110*18","cliId":"","pno":"22\/8054489-2","cno":"","email":"","ename":"","eno":"","pphy":"KSIONSKI, SEBASTIAN MD","ppno":"434\/315-5340","pcpadd":"935 S MAIN ST","pcpcity":"FARMVILLE","pcpstate":"VA","pcpzip":23901,"pcpcounty":"","pcpid":"","pcpname":"CENTRA MEDICAL GROUP LLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","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":["R10.11","K52.9","R10.13","S39.91XA","G89.18","G89.29","F17.210","R82.71","Z82.49","Y04.2XXA","F43.25","M54.17","D72.829","R07.89","R05.","M54.5","Z88.0","Z88.6","Z88.2","Z88.8","Z20.822","Z79.899","Z87.11","M54.2","M54.9","M53.3","K63.5","R19.4","K64.8","R10.32","R61.","R10.84","Z23.","M54.12","R20.2","M79.604","N13.30","R22.0","W01.0XXA","M51.36","R20.0","M54.16","K62.5","R10.9","I10.","K92.1","R13.10","K81.9","D68.51","Z88.1","Z90.721","Z88.5","S50.01XA","S10.91XA","S20.311A","R07.0","M25.521","R51.9","S81.012A","N39.0","N83.201","J02.9","NO DATA","Z72.0","M71.38","S00.03XA","N83.202","R16.0","R11.0","R19.7","M46.1","M47.816","M25.529","S16.1XXA","W17.89XA","Y92.89","Y93.K1","S99.921A","N94.6","R09.81","K59.00"],"date":["2021-02-04","2021-10-26","2020-09-10","2020-12-06","2020-12-06","2020-12-06","2021-08-22","2020-12-06","2020-12-06","2020-12-06","2020-12-15","2021-07-08","2021-10-26","2021-08-22","2021-08-22","2021-08-22","2021-08-22","2021-08-22","2021-08-22","2021-08-22","2021-08-22","2021-08-22","2020-05-24","2021-03-15","2020-08-17","2021-12-07","2020-09-14","2020-09-14","2020-09-14","2020-09-14","2020-09-29","2021-07-28","2020-09-29","2021-06-18","2021-08-05","2021-08-05","2021-10-26","2020-05-15","2020-05-15","2021-06-18","2021-06-18","2021-06-18","2021-12-25","2021-12-25","2021-12-25","2021-12-25","2020-01-15","2020-12-02","2020-11-17","2020-11-28","2020-11-17","2020-11-28","2021-03-15","2021-03-15","2021-03-15","2021-03-15","2021-03-15","2021-03-15","2020-08-01","2020-08-11","2020-08-11","2021-08-19","2021-12-07","2021-12-07","2021-10-05","2020-08-01","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2021-02-04","2020-09-03","2021-03-31","2021-06-11","2021-06-11","2021-06-11","2021-06-11","2019-07-03","2019-05-19","2019-12-20","2019-07-27"],"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":[["","00406012301","HYDROCO\/APAP","TAB 5-325MG","8","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","","GABAPENTIN","CAP 300MG","","Select","Select",""],["","","QUETIAPINE","TAB 50MG ER","","Select","Select",""],["","69097083412","SERTRALINE","TAB 50MG","30","Select","Select",""],["","00054023525","MORPHINE","TAB 15MG","14","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","20","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","49884093547","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","30","Select","Select",""],["","00093221001","SUCRALFATE","TAB 1GM","30","Select","Select",""],["","","SMZ\/TMP","TAB 800-160","","Select","Select",""],["","","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","00143312601","DICYCLOMINE","CAP 10MG","112","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","71093014105","METHOCARBAM","TAB 750MG","42","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","","BUT\/APAP\/CAF","CAP ","","Select","Select",""],["","","HYDROMORPHON","TAB 2MG","","Select","Select",""],["","","LEVOFLOXACIN","TAB 500MG","","Select","Select",""],["","","CVS","DIS 21MG\/24H","","Select","Select",""],["","","OXYCOD\/APAP","TAB 5-325MG","","Select","Select",""],["","","CYCLOBENZAPR","TAB 5MG","","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","30","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","20","Select","Select",""],["","","NAPROXEN","TAB 500MG","","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","20","Select","Select",""],["","","GLYCOPYRROL","TAB 1MG","","Select","Select",""],["","","NARCAN","SPR ","","Select","Select",""],["","45802091987","CETIRIZINE","TAB 10MG","7","Select","Select",""],["","00591570801","CLINDAMYCIN","CAP 150MG","28","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","60505264807","TIZANIDINE","CAP 2MG","20","Select","Select",""],["","51293081101","PHENAZOPYRID","TAB 200MG","6","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","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":""}]}]}