{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   ADNAMATTENRUB G","gend":1,"add":"EC 102DR RAD","city":"RINGGOLD","state":"VA","zip":"24586-9998","dob":"1976-04-02","age":"","mstatus":"","insh":"74200210*15","cliId":"","pno":"17\/4346309-3","cno":"","email":"","ename":"","eno":"","pphy":"WINFIELD, ALBERT C MD","ppno":"434\/791-4110","pcpadd":"173 EXECUTIVE DRIVE","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":"","pcpname":"PROVIDENCE FAMILY AND SPORTS MEDICINE INC","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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M79.7","M50.30","R51.","I10.","Z13.89","M54.6","M41.9","F41.9","Z79.899","M13.0","M54.40","G62.9","R79.89","G57.02","Z72.0","K21.9","Z79.891","Z28.89","H00.11","Z98.890","NO DATA","M41.35","Z01.419","Z71.9","Z28.21","R30.0","H00.025","M41.24","M47.814","M53.3","F32.9","F90.0","M51.34","M51.16","M54.5","M47.816","B34.9","M54.9","M89.8X1","M25.559","G89.29","Z98.1","J20.9","G43.909","N20.0","J30.9","Z20.822","M79.1","M41.80","Z76.89","F33.2","M54.2","J02.9","M54.12","S46.812A","F90.9","M47.812","R10.31","R10.32","R10.33","J32.9","F17.210","Z68.20","F06.32","N39.0","R11.0","M79.641","M79.642","M54.14","F43.21","R21.","R10.9","F17.200","M77.12","L98.9","Z68.23","R07.9","M79.602","F12.10","F11.10","F15.10","Z88.1","Z88.8","Z53.20","Z68.24","M25.522","M51.36","N80.9","B07.9"],"date":["2021-03-19","2021-09-30","2020-01-23","2022-01-05","2020-01-23","2021-08-25","2021-10-27","2020-11-23","2020-12-07","2021-03-19","2021-03-19","2020-12-07","2020-12-07","2020-12-07","2021-07-15","2020-12-07","2020-09-02","2022-10-04","2020-10-16","2021-10-27","2021-10-27","2021-10-27","2022-10-04","2022-10-04","2021-07-15","2020-03-01","2020-03-01","2022-09-21","2021-08-25","2022-09-21","2020-11-23","2020-11-23","2021-09-30","2021-09-30","2020-04-30","2022-11-10","2021-01-01","2021-03-06","2021-03-19","2021-05-19","2022-11-10","2021-10-27","2021-12-08","2021-12-08","2021-12-08","2021-12-08","2021-12-08","2020-07-08","2020-07-08","2020-09-02","2019-04-30","2019-04-30","2019-03-01","2019-04-05","2019-05-08","2019-03-18","2019-04-30","2019-08-26","2019-08-26","2019-08-26","2019-09-18","2019-09-18","2019-09-18","2019-03-17","2019-01-10","2019-01-10","2019-08-02","2019-08-02","2019-03-15","2019-05-08","2019-05-15","2019-06-20","2019-06-20","2022-04-27","2022-07-14","2022-07-14","2022-01-05","2022-01-05","2022-01-05","2022-01-05","2022-01-05","2022-01-05","2022-01-05","2022-01-05","2022-06-16","2022-04-14","2022-09-21","2022-10-04","2022-11-18"],"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":[["","00456112030","VIIBRYD","TAB 20MG","30","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","30","Select","Select",""],["","65162047505","NORETHIN","TAB 5MG","60","Select","Select",""],["","00093226301","AMOXICILLIN","TAB 500MG","30","Select","Select",""],["","45802046564","KETOCONAZOLE","SHA 0.02","120","Select","Select",""],["","00603533831","PREDNISONE","PAK 10MG","48","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","8","Select","Select",""],["","00832105410","BACLOFEN","TAB 10MG","30","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00254100752","ALBUTEROL","AER HFA","7","Select","Select",""],["","65162089129","MOMETASONE","SPR 50MCG","17","Select","Select",""],["","45963030509","DEXTROAMPHET","CAP 15MG ER","30","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","71930002643","BROM\/PSE\/DM","SYP ","300","Select","Select",""],["","65862052405","GABAPENTIN","TAB 800MG","360","Select","Select",""],["","65862045460","ALPRAZOLAM","TAB 0.5MG ER","30","Select","Select",""],["","50742065601","CARISOPRODOL","TAB 350MG","90","Select","Select",""],["","75834002001","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","43598029390","PREGABALIN","CAP 75MG","60","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","21","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","16","Select","Select",""],["","54092038501","ADDERALL","CAP 15MG","30","Select","Select",""],["","52054051409","DEXEDRINE","CAP 15MG CR","30","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","00603497528","OXYBUTYNIN","TAB 5MG","90","Select","Select",""],["","","POLYMYXIN","SOL TRIMETHP","","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","6","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","","TIZANIDINE","TAB 4MG","","Select","Select",""],["","51991007301","BUT\/APAP\/CAF","CAP CODEINE","32","Select","Select",""],["","","TOBRA\/DEXAME","SUS 0.3-0.1%","","Select","Select",""],["","00069047103","CHANTIX","PAK 0.5& 1MG","53","Select","Select",""],["","00093220305","METOCLOPRAM","TAB 10MG","90","Select","Select",""],["","00071101468","LYRICA","CAP 75MG","60","Select","Select",""],["","","BACITRACIN","OIN OP","","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","43598075201","BUPROPION","TAB 150MG SR","60","Select","Select",""],["","75826011510","PHENAZOPYRID","TAB 200MG","6","Select","Select",""],["","00085113204","PROVENTIL","AER HFA","7","Select","Select",""],["","64380080307","RANITIDINE","TAB 150MG","20","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","65862053750","LEVOFLOXACIN","TAB 500MG","10","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":""}]}]}