{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   LLECRAMNAMLLAG I","gend":0,"add":"NARG 3151TS ELLIV","city":"LYNCHBURG","state":"VA","zip":"24502-9998","dob":"1987-06-08","age":"","mstatus":"","insh":"67200210*64","cliId":"","pno":"52\/4349448-3","cno":"","email":"","ename":"","eno":"","pphy":"DOYLE, ANDREW M DO","ppno":"434\/200-3908","pcpadd":"125 NATIONWIDE DR","pcpcity":"LYNCHBURG","pcpstate":"VA","pcpzip":24502,"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":["L02.612","L03.116","M16.52","L02.619","L03.119","M79.672","D72.829","Z98.890","L97.522","L57.0","L84.","M21.41","L20.89","M77.41","M20.41","M21.611","L72.8","L20.84","M17.32","Z47.89","L28.0","F17.210","B95.7","Z82.49","L08.9","M17.12","M25.562","L20.9","B35.4","R30.0","L81.0","L85.3","S46.012A","M25.512","L05.91","Z87.2","M21.6X1","L21.8","L29.8","L82.1","S89.92XA","M24.521","K50.90","M23.52","M75.42","R21.","M79.671","M77.42","K21.9","K92.1","Z71.9","S61.412A","S61.411A","W25.XXXA","Z23."],"date":["2020-10-05","2019-01-05","2019-04-30","2019-11-08","2019-11-08","2021-07-06","2019-11-08","2019-11-21","2020-10-05","2022-11-03","2022-11-03","2020-09-14","2021-12-07","2022-11-03","2022-11-03","2020-08-12","2021-06-07","2021-01-05","2022-03-08","2020-10-13","2021-06-07","2019-07-23","2019-01-02","2019-01-02","2020-10-05","2020-09-18","2020-09-18","2019-05-01","2019-05-01","2019-05-01","2020-03-05","2020-03-05","2021-03-26","2021-03-26","2021-12-07","2020-12-15","2019-12-02","2020-03-05","2020-03-05","2020-02-20","2019-04-15","2019-04-15","2022-05-18","2021-02-26","2019-09-17","2019-09-17","2021-07-06","2022-01-11","2022-05-18","2022-05-18","2022-05-18","2022-01-11","2022-01-11","2022-01-09","2022-01-09"],"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":[["","00363032706","GENTLE","TAB 5MG EC","2","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","20","Select","Select",""],["","45802091987","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","59779060998","CVS","GUM 4MG ORIG","170","Select","Select",""],["","00009540001","NICOTROL","INH ","168","Select","Select",""],["","00363042198","NICOTINE","GUM 4MG REF","170","Select","Select",""],["","16729054235","FLUOROURACIL","CRE 0.05","40","Select","Select",""],["","70700015010","OMEPRAZOLE","CAP 20MG","90","Select","Select",""],["","45802086803","POLYETH","POW 3350 NF","510","Select","Select",""],["","","TERBINAFINE","TAB 250MG","","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","68462053465","TACROLIMUS","OIN 0.001","60","Select","Select",""],["","","FLUOCINONIDE","SOL 0.0005","","Select","Select",""],["","68462029052","AUG","CRE 0.0005","50","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","68462060965","PIMECROLIMUS","CRE 0.01","60","Select","Select",""],["","","DOXYCYC","CAP 100MG","","Select","Select",""],["","00713032737","BETAMETH","OIN 0.001","45","Select","Select",""],["","00713022515","TRIAMCINOLON","CRE 0.001","45","Select","Select",""],["","","AMMONIUM","CRE 0.12","","Select","Select",""],["","","KETOCONAZOLE","CRE 0.02","","Select","Select",""],["","","LAMISIL","CRE 0.01","","Select","Select",""],["","","SARNA","LOT 0.01","","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":""}]}]}