{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  ATSIRTSREYM N ","gend":1,"add":"1 4001TS HT2","city":"ALTAVISTA","state":"VA","zip":"24517-9998","dob":"1985-09-17","age":"","mstatus":"","insh":"9791110*68","cliId":"","pno":"04\/4342453-1","cno":"","email":"","ename":"","eno":"","pphy":"KRZYZANOWSKI, SUZANNE K MD","ppno":"434\/200-5200","pcpadd":"SUITE 10 2323 MEMORIAL AVE","pcpcity":"LYNCHBURG","pcpstate":"VA","pcpzip":24501,"pcpcounty":"","pcpid":"","pcpname":"CENTRA MEDICAL GROUP LLC","plan":"OHP","program":"MEDICAID","lob":"M4","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":["F33.1","L98.7","E65.","L30.4","Z98.84","G89.29","E66.9","Z68.34","R73.03","I10.","E78.5","F41.9","M54.42","M47.816","M54.41","S83.412A","S89.92XA","Z68.35","K21.9","R73.01","F33.40","R82.998","J45.909","E66.01","Z00.00","B02.9","M54.9","Z79.899","G89.4","R76.8","M79.7","O26.90","Z68.42","M79.661","Z87.891","M54.12","M53.3","M54.16","M25.572","Z68.38","F32.9","M54.5","M17.11","G60.3","Z71.3","N61.1","R51.","N93.9","R60.0","M25.561","E16.1","Z97.5"],"date":["2020-04-29","2020-07-13","2020-07-13","2020-07-13","2020-07-30","2021-08-15","2020-06-24","2020-02-27","2020-02-27","2021-02-19","2021-02-19","2020-02-27","2020-04-03","2020-04-03","2020-04-03","2021-11-03","2021-11-03","2020-06-24","2021-02-19","2020-06-24","2020-06-24","2021-02-19","2021-02-19","2021-02-19","2020-07-30","2021-08-15","2021-08-15","2019-09-16","2019-09-16","2019-12-03","2019-12-03","2019-12-03","2019-01-11","2019-01-17","2019-05-13","2019-09-13","2019-09-13","2019-07-11","2019-09-13","2019-06-28","2019-11-17","2019-02-06","2019-05-16","2019-09-13","2019-07-12","2019-05-13","2019-05-13","2019-11-17","2019-01-17","2019-07-01","2019-07-01","2019-11-19"],"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":[["","57664064888","CHLORTHALID","TAB 25MG","15","Select","Select",""],["","47335034483","CETIRIZINE","CHW 10MG","30","Select","Select",""],["","24208067004","SOD","SOL 10% OP","15","Select","Select",""],["","31722070530","VALACYCLOVIR","TAB 1GM","21","Select","Select",""],["","71085000300","DICLOFENAC","GEL 0.03","100","Select","Select",""],["","","ESCITALOPRAM","TAB 10MG","","Select","Select",""],["","59310057922","PROAIR","AER ","17","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","00378912198","FENTANYL","DIS 25MCG\/HR","10","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","30","Select","Select",""],["","50383093335","LIDOCAINE","OIN 0.05","177","Select","Select",""],["","24658031205","DOXYCYCL","TAB 100MG","20","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","00603533715","PREDNISONE","PAK 5MG","21","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","20","Select","Select",""],["","60505384801","CELECOXIB","CAP 100MG","30","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","63304069205","CLINDAMYCIN","CAP 150MG","28","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","43547030403","ARIPIPRAZOLE","TAB 10MG","30","Select","Select",""],["","40085071645","DOXEPIN","CRE 0.05","45","Select","Select",""],["","52565000730","LIDO\/PRILOCN","CRE 2.5-2.5%","90","Select","Select",""],["","60505025103","TIZANIDINE","TAB 2MG","20","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","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":""}]}]}