{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   ATREBORNILREHS F","gend":1,"add":"OB OP404 X","city":"SPOUT SPRING","state":"VA","zip":"24593-9998","dob":"1964-09-11","age":"","mstatus":"","insh":"84300210*44","cliId":"","pno":"66\/4341880-0","cno":"","email":"","ename":"","eno":"","pphy":"BEE, ROBERT 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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J45.40","M79.671","G57.61","J45.909","R06.02","E11.65","E78.5","I10.","E03.9","R39.81","M54.5","G90.09","N39.41","R06.09","S91.209A","F31.30","F31.61","Z63.4","G89.29","F31.9","Z86.73","E11.9","Z82.49","M79.89","I42.9","H92.01","H69.91","H49.01","R06.9","R09.02","T78.40XA","J20.9","F41.8","F31.70","E66.9","F41.1","L60.8","B35.1","M79.675","M79.674","E11.40","NO DATA","M51.36","M54.16","H49.02","R06.00","R60.0","J45.901","S22.060A","B02.9","M25.551","M70.61","E10.51","J45.20","E11.42","F31.81","M54.9","Z79.4","E11.39","H53.2","I67.1","N30.00","E78.01","E03.4","R51.","S39.012A","H49.22","H05.20","H49.9","Z79.82","B96.20","E78.00","Z79.890","N39.0","M62.830","H53.8","Z72.3","N39.46","F31.32","Z12.11","Z79.02","L60.0","L03.031","R92.8","N32.81","E55.9","M47.816","S91.101A","R07.89"],"date":["2022-06-08","2020-12-22","2020-12-22","2021-09-14","2022-03-15","2022-09-13","2022-06-08","2022-06-08","2022-06-08","2022-11-06","2021-09-11","2022-11-06","2022-11-06","2021-10-01","2021-10-01","2021-11-08","2022-04-20","2021-11-22","2021-05-13","2022-09-21","2021-09-14","2022-02-09","2021-09-14","2021-09-20","2021-09-28","2020-05-07","2020-05-07","2020-10-06","2021-02-15","2021-02-15","2021-02-17","2021-02-17","2021-04-16","2021-05-27","2022-04-20","2021-05-27","2022-08-24","2022-08-24","2022-08-24","2022-08-24","2022-08-10","2022-05-09","2022-05-09","2022-05-09","2020-01-21","2021-09-14","2022-04-20","2021-02-15","2021-07-28","2020-01-27","2020-07-24","2020-07-24","2020-12-01","2020-01-27","2022-04-20","2019-08-29","2019-10-21","2022-06-08","2019-10-29","2019-12-30","2019-12-30","2019-09-08","2019-09-08","2019-09-08","2019-09-08","2019-07-15","2019-09-08","2019-09-08","2019-09-08","2022-06-08","2019-09-08","2019-09-08","2022-06-08","2019-07-09","2019-07-09","2019-09-07","2022-04-20","2022-06-08","2022-11-16","2022-06-08","2022-06-08","2022-08-24","2022-08-24","2022-04-11","2022-06-09","2022-02-02","2022-03-07","2022-08-24","2022-03-15"],"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":[["","00088221905","LANTUS","INJ 100\/ML","45","Select","Select",""],["","69238183001","LEVOTHYROXIN","TAB 25MCG","15","Select","Select",""],["","50228018005","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","69618004610","ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","13668022090","ARIPIPRAZOLE","TAB 20MG","30","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","45","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","100","Select","Select",""],["","","SYMBICORT","AER 80-4.5","","Select","Select",""],["","68001010600","DIVALPROEX","TAB 500MG ER","150","Select","Select",""],["","69315011610","FUROSEMIDE","TAB 20MG","5","Select","Select",""],["","08396900100","CLICKFINE","MIS 31GX1\/4\"","200","Select","Select",""],["","42806016101","HYDROXYZ","TAB 50MG","120","Select","Select",""],["","68001015303","CARVEDILOL","TAB 3.125MG","60","Select","Select",""],["","60505258009","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","68001033200","LISINOPRIL","TAB 2.5MG","30","Select","Select",""],["","29300016815","TIZANIDINE","TAB 2MG","14","Select","Select",""],["","00487950125","ALBUTEROL","NEB 0.00083","75","Select","Select",""],["","13107000334","MIRTAZAPINE","TAB 30MG","30","Select","Select",""],["","61442010305","DICLOFENAC","TAB 75MG DR","28","Select","Select",""],["","","BUDES\/FORMOT","AER 80-4.5","","Select","Select",""],["","67877052790","SOLIFENACIN","TAB 5MG","30","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","08222710048","PEN  NEEDLES","MIS 31GX6MM","200","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","","GNP","TAB 81MG EC","","Select","Select",""],["","53489011905","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","16729016917","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","10","Select","Select",""],["","00378005301","CIMETIDINE","TAB 200MG","14","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","51224012250","AZITHROMYCIN","TAB 500MG","3","Select","Select",""],["","67877021660","CEFUROXIME","TAB 500MG","14","Select","Select",""],["","43598081115","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","43547039910","CYCLOBENZAPR","TAB 5MG","21","Select","Select",""],["","68382005101","MELOXICAM","TAB 15MG","10","Select","Select",""],["","00378034501","DIAZEPAM","TAB 5MG","1","Select","Select",""],["","33332032101","AFLURIA","INJ 2021-22","0","Select","Select",""],["","65862007930","TERBINAFINE","TAB 250MG","90","Select","Select",""],["","91237000173","EASY","MIS 31GX1\/4\"","200","Select","Select",""],["","65162062711","TRAMADOL","TAB 50MG","5","Select","Select",""],["","","VALACYCLOVIR","TAB 1GM","","Select","Select",""],["","31604002678","D3","CAP 2000UNIT","30","Select","Select",""],["","","NAPROXEN","TAB 500MG","","Select","Select",""],["","","CEFDINIR","CAP 300MG","","Select","Select",""],["","91237000128","ALCOHOL","PAD ","200","Select","Select",""],["","00536379001","VITAMIN","CAP 2000UNIT","30","Select","Select",""],["","70877858801","TALIVA","CAP ","60","Select","Select",""],["","00002879959","HUMALOG","INJ 100\/ML","15","Select","Select",""],["","00002771559","BASAGLAR","INJ 100UNIT","45","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":""}]}]}