{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WENNELL   R PATRICK","gend":1,"add":"905 VIRGINIA STREET","city":"LYNCHBURG                     ","state":"VA","zip":"24504-3549","dob":"1985-02-06","age":"","mstatus":"","insh":4662080,"cliId":"","pno":4344660557,"cno":"","email":"","ename":"","eno":"","pphy":"WORTLEY, GEORGE C","ppno":5408282634,"pcpadd":"2323 Memorial Ave,Ste 10","pcpcity":"Lynchburg                     ","pcpstate":"VA","pcpzip":245012652,"pcpcounty":"","pcpid":"","pcpname":"CENTRA MEDICAL GROUP","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"905 VIRGINIA STREET","add3":"","madd1":"905 VIRGINIA STREET","madd2":"","madd3":"","mcity":"LYNCHBURG                     ","mstate":"VA","mzip":"24504-3549","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R31.29","R35.0","R10.32","R10.2","R31.21","R87.610","R87.810","R87.619","N32.81","Z11.3","M79.604","M54.31","Z20.828","M25.561","M54.5","M54.16","M79.641","M54.10","M79.601","M79.621","N76.0","Z01.419","Z11.4","R31.9","G35","R53.1","E55.9","F17.210","R73.9","T38.0X5A","N39.41","E66.9","Z68.38","Z83.3","Z82.3","R27.0","R90.82","R90.89","Z72.0","G37.9","F44.5","G81.91","G89.0","E66.01","Z68.39","R74.8","R48.2","R25.8","R26.0","D72.829","Z79.899","R41.82","F80.81","M79.2","F41.9","Z87.891","Z79.01","F44.9","R51.9","Z09","R32","R13.10","E61.0","E53.8","R73.03","G93.9","R46.89","Z45.2","Z49.01","R25.2","M79.602","M79.605","E56.8","R22.31","M79.89","G47.19","H53.2","R52","G89.29","F17.200","Z91.81","Z79.891","G47.9","Z51.81","M62.81","R27.8","R26.2","R73.09","R94.5","L29.9","L50.0","N31.9","G47.33","B37.3","R41.9"],"date":["2020-01-06","2021-05-14","2020-01-06","2020-09-09","2020-09-09","2020-09-09","2020-09-09","2020-01-10","2020-10-30","2020-09-09","2020-11-03","2020-06-24","2020-09-24","2020-07-06","2020-07-06","2020-07-06","2020-09-03","2020-09-03","2020-11-05","2020-09-04","2021-07-02","2020-09-09","2020-09-09","2020-09-09","2021-12-09","2020-11-02","2021-05-14","2021-05-24","2020-09-23","2020-09-24","2020-09-17","2020-09-17","2020-09-30","2020-09-30","2020-09-30","2020-09-24","2020-09-17","2020-09-18","2021-03-22","2021-02-17","2020-12-29","2020-11-02","2021-03-22","2021-05-24","2020-09-24","2020-09-24","2020-09-24","2020-09-24","2020-09-24","2020-09-24","2021-05-24","2020-10-01","2020-09-30","2021-12-08","2020-10-30","2020-09-30","2020-09-30","2020-10-07","2020-10-07","2020-10-07","2020-11-11","2020-11-11","2020-11-04","2020-10-30","2020-11-05","2020-10-30","2020-11-02","2020-11-01","2020-11-06","2020-11-05","2020-11-03","2020-11-03","2020-11-05","2020-11-05","2020-11-05","2020-11-11","2020-11-11","2020-11-11","2020-12-29","2020-12-29","2020-12-29","2020-12-29","2021-01-07","2021-03-22","2021-04-06","2021-04-06","2021-03-30","2021-05-14","2021-05-18","2021-05-24","2021-05-24","2021-12-08","2021-06-30","2021-07-02","2021-12-08"],"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":[]},{"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":[["","42806016005","HYDROXYZ","TAB 25MG","90","Select","Select",""],["","31604002518","MULTI","TAB \/IRON","30","Select","Select",""],["","69097081507","GABAPENTIN","CAP 400MG","270","Select","Select",""],["","51991074710","DULOXETINE","CAP 30MG","90","Select","Select",""],["","45802048678","DOCUSATE","CAP 100MG","60","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","30","Select","Select",""],["","62756052169","SUMATRIPTAN","TAB 50MG","9","Select","Select",""],["","00832105410","BACLOFEN","TAB 10MG","90","Select","Select",""],["","51991029201","OXCARBAZEPIN","TAB 150MG","60","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","28","Select","Select",""],["","00093216568","NALOXONE","SPR 4MG","2","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0.3","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","5","Select","Select",""],["","00536106210","STOOL","CAP 100MG","60","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","4","Select","Select",""],["","00904672080","ACETAMIN","TAB 500MG","180","Select","Select",""],["","68382025601","OXYBUTYNIN","TAB 10MG ER","90","Select","Select",""],["","60505025203","TIZANIDINE","TAB 4MG","56","Select","Select",""],["","10702025350","BUT\/APAP\/CAF","TAB ","28","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","28","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","20","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","15","Select","Select",""],["","00093598627","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","69097012303","TOPIRAMATE","TAB 50MG","60","Select","Select",""],["","00904053060","TAB-A-VITE","TAB ","90","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":""}]}]}