{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BLAZE   Z TISDALE","gend":1,"add":"100 NORTH MARKET ST","city":"KENBRIDGE","state":"VA","zip":"23944-9998","dob":"1937-06-21","age":"","mstatus":"","insh":"900038931*01","cliId":"","pno":"434\/262-8493","cno":"","email":"","ename":"","eno":"","pphy":"MARCH, ALEXANDRA NP","ppno":"434\/315-5340","pcpadd":"935 S MAIN STREET","pcpcity":"FARMVILLE","pcpstate":"VA","pcpzip":23901,"pcpcounty":"","pcpid":"","pcpname":"CENTRA MEDICAL GROUP LLC","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/315-5920","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R07.89","C50.919","C79.51","R07.9","Z74.3","M79.622","N23.","N39.0","J18.9","U07.1","J12.89","J96.01","N17.9","B96.20","J44.9","E11.65","Z90.11","Z92.21","Z79.899","E86.0","E11.69","C50.911","R00.1","D84.9","J44.0","J44.1","N18.3","Z85.3","N28.1","N93.9","R10.33","Z20.828","Z11.59","D64.9","E04.2","M85.80","R05.","R53.83","R06.02","F17.200","I12.9","F32.9","E78.5","E66.9","E55.9","E11.22","E05.00","F17.210","I25.10","I25.2","L68.0","K21.9","K59.00","N18.30","E07.9","R53.82","M79.606","M25.50","Z79.811","E04.1","G47.30","R32.","S01.01XA","W01.0XXA","R39.9","Z72.0","I50.9","F31.9","M10.9","Z87.898","D61.818","E04.9","Z79.818","S22.39XA","S22.49XA","T76.11XA","Z90.10","S22.32XA","Z16.12","D05.11","Z17.0","K08.9","N39.46","R82.90","J81.1","T74.11XA","R63.5","S01.80XA","S01.90XA","M79.604","D75.9","J43.9","E05.20","N18.9","D63.8","E11.641","M62.81","D89.9","D63.1","M54.5","I51.7","R91.8","Z91.81","S01.81XA","C73.","I13.0","G47.33","R63.4","I10.","N28.9","E11.649","D61.811","X58.XXXA","S19.9XXA","S09.90XA","R10.32","G47.00","Z48.02","Z87.891","C79.89","R53.1","I13.10","R09.02","R63.0","C80.0","C79.9","W19.XXXA","E05.90","L29.9","L28.2","R23.8","L85.3","Z74.09","F41.9","S22.42XA","B96.1","Z08.","Z85.830","I95.9","R43.9","Z86.19","E07.89","R43.8","Z87.440","Z99.89","M20.41","M20.42","G60.9","M79.675","M79.674","B35.1","F32.A","R30.9"],"date":["2020-07-30","2021-10-14","2021-10-20","2020-08-04","2021-07-07","2020-07-30","2020-08-18","2020-10-14","2020-08-18","2020-10-14","2020-08-28","2020-08-28","2020-08-28","2020-08-28","2021-10-20","2020-08-19","2021-10-20","2020-12-18","2021-03-30","2020-08-21","2020-08-20","2021-10-20","2020-08-25","2020-08-27","2020-08-28","2020-08-28","2020-08-28","2021-07-14","2020-09-14","2020-09-14","2020-09-14","2020-10-08","2020-10-08","2020-10-14","2021-10-20","2021-10-20","2020-10-14","2021-02-08","2020-10-14","2020-10-14","2021-10-20","2021-07-15","2021-10-20","2021-10-20","2021-03-30","2021-10-20","2021-10-20","2021-10-20","2021-10-20","2021-10-20","2021-10-20","2021-10-20","2021-10-20","2021-10-20","2021-02-08","2021-02-08","2021-02-08","2021-02-08","2021-10-20","2021-03-30","2021-03-30","2021-03-30","2021-07-07","2021-05-15","2020-05-26","2021-12-01","2021-03-01","2021-07-14","2020-05-26","2020-05-26","2021-03-30","2021-07-15","2020-06-10","2020-07-30","2020-08-01","2020-08-04","2020-08-01","2020-08-03","2020-08-23","2021-03-30","2021-07-15","2020-07-22","2020-10-14","2021-07-14","2020-08-18","2021-02-08","2021-03-01","2021-05-15","2021-07-07","2021-07-07","2020-03-31","2020-08-01","2020-08-17","2020-12-18","2020-08-27","2020-08-27","2020-08-27","2020-08-28","2020-08-28","2020-11-18","2020-11-18","2020-12-22","2021-07-14","2021-05-15","2021-10-14","2020-08-01","2020-08-18","2020-03-02","2020-06-10","2020-08-18","2020-08-18","2020-11-18","2021-07-07","2021-07-07","2021-07-07","2021-07-14","2021-07-14","2021-07-14","2021-07-14","2020-03-02","2020-09-14","2020-08-18","2020-08-22","2020-08-22","2020-09-14","2021-07-07","2021-07-07","2021-07-15","2021-12-01","2021-12-01","2021-12-01","2021-12-01","2021-12-01","2020-05-26","2020-08-04","2020-08-02","2020-10-14","2020-10-14","2020-10-14","2020-12-18","2020-12-18","2020-12-18","2020-12-18","2020-12-18","2020-12-18","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-10-20","2020-09-14"],"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":[]}]},{"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":[["","00378668877","PANTOPRAZOLE SODIUM                                                   ","20MG","90","Select","Select",""],["","00536100901","FERROUS SULFATE                                                       ","325MG","30","Select","Select",""],["","13107003134","MIRTAZAPINE                                                           ","15MG","-90","Select","Select",""],["","29300013801","DIVALPROEX SODIUM DR                                                  ","125MG DR","90","Select","Select",""],["","00781531701","ZOLPIDEM TARTRATE                                                     ","5MG","14","Select","Select",""],["","62175027037","OXYBUTYNIN CHLORIDE ER                                                ","5MG ER","90","Select","Select",""],["","64380080438","RANITIDINE HCL                                                        ","300MG","30","Select","Select",""],["","57896010210","ACETAMINOPHEN                                                         ","325MG","120","Select","Select",""],["","29300035005","ALLOPURINOL                                                           ","300MG","90","Select","Select",""],["","00904582460","VITAMIN D3                                                            ","1000UNIT","30","Select","Select",""],["","69315011710","FUROSEMIDE                                                            ","40MG","60","Select","Select",""],["","68001015504","ANASTROZOLE                                                           ","1MG","60","Select","Select",""],["","00069048603","IBRANCE                                                               ","100MG","21","Select","Select",""],["","65862042005","SULFAMETHOXAZOLE\/TRIMETHOPRIM DS                                      ","800-160","20","Select","Select",""],["","00904552987","HEARTBURN RELIEF                                                      ","RELIEF","56","Select","Select",""],["","68001042300","NITROFURANTOIN MONOHYDRATE\/MACROCRYSTALS                              ","100MG","14","Select","Select",""],["","00536117801","MECLIZINE HCL                                                         ","12.5MG","30","Select","Select",""],["","00904555159","BANOPHEN                                                              ","25MG","45","Select","Select",""],["","55111012705","CIPROFLOXACIN HYDROCHLORIDE                                           ","500MG","20","Select","Select",""],["","45802016000","DICLOFENAC SODIUM                                                     ","1%","100","Select","Select",""],["","13668056904","CLOBETASOL PROPIONATE                                                 ","0.05%","45","Select","Select",""],["","00093314705","CEPHALEXIN                                                            ","500MG","20","Select","Select",""],["","00093506105","HYDROXYZINE HYDROCHLORIDE                                             ","25MG","6","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":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"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":""}]}]}