{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MATTHEW   A CRUMLEY","gend":0,"add":"902 FOREST AVE","city":"GROTTOES","state":"VA","zip":"24441-9998","dob":"1990-10-14","age":"","mstatus":"","insh":"2014830*01","cliId":"","pno":"252\/996-0472","cno":"252\/996-0472","email":"","ename":"","eno":"","pphy":"DUTCHER, TITUS L MD","ppno":"540\/234-9241","pcpadd":"1151 KEEZLETOWN RD SUITE 101","pcpcity":"WEYERS CAVE","pcpstate":"VA","pcpzip":24486,"pcpcounty":"","pcpid":147705,"pcpname":"Radford Student Health Center","plan":"OHP","program":"ACA","lob":"Individual","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/234-9200","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","F98.8","F41.1","G89.29","M25.572","G62.9","F45.42","Z79.899","Z48.89","M21.41","M67.01","M25.571","M76.821","M76.822","M67.02","M96.0","M21.42","M65.9","T84.498D","M79.672","L60.0","M79.2","Z79.891","M54.5","Z98.890","N34.1","G57.72","M99.06","N52.9","N45.1","R68.82","Z96.7","R93.7","M79.10","G57.82","M79.674","G89.28","Z20.828","M19.072","Z09.","R06.09","L02.91","L72.3","F45.41","B07.0","G89.4","M79.671","M54.50"],"date":["2021-10-14","2021-10-25","2021-11-18","2021-07-22","2021-07-27","2021-07-22","2021-07-22","2021-07-22","2021-07-27","2021-11-22","2021-11-22","2021-07-27","2021-11-22","2021-11-22","2021-11-22","2021-11-22","2021-11-22","2021-11-22","2020-04-27","2021-11-22","2021-11-22","2021-09-02","2021-09-02","2021-09-02","2021-06-07","2021-01-20","2021-11-18","2020-03-30","2021-02-12","2021-02-12","2021-02-12","2020-09-28","2020-09-28","2020-12-28","2021-04-02","2021-05-24","2021-11-22","2020-07-25","2020-10-09","2020-11-20","2020-07-25","2021-05-10","2021-05-10","2021-05-10","2021-07-27","2021-11-18","2021-11-22","2021-11-18"],"priorHcc":[null,"",null,"","","","","","",null,null,"",null,null,null,null,null,null,"",null,null,"","","","","",null,"","","","","","","","","",null,"","","","","","","","",null,null,null]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","00574220145","TRETINOIN","0.10%","45","Select","Select",""],["","70710122600","AMITRIPTYLIN","25MG","45","Select","Select",""],["","10702005601","OXYCODONE","10MG","60","Select","Select",""],["","00527150537","AMPHET\/DEXTR","20MG","60","Select","Select",""],["","00093083205","CLONAZEPAM","0.5MG","60","Select","Select",""],["","68180052001","LISINOP\/HCTZ","20-25MG","30","Select","Select",""],["","65862050320","AMOX\/K","875-125","10","Select","Select",""],["","00228212750","CLONIDINE","0.1MG","60","Select","Select",""],["","88888888887","DMR","","1","Select","Select",""],["","68462010530","ONDANSETRON","4MG","30","Select","Select",""],["","00832105410","BACLOFEN","10MG","360","Select","Select",""],["","42858010401","OXYCOD\/APAP","10-325MG","90","Select","Select",""],["","43598029590","PREGABALIN","150MG","60","Select","Select",""],["","16571020106","DICLOFENAC","75MG DR","60","Select","Select",""],["","57844012001","ADDERALL","20MG","60","Select","Select",""],["","00093310905","AMOXICILLIN","500MG","24","Select","Select",""],["","69097012203","TOPIRAMATE","25MG","60","Select","Select",""],["","69097094312","GABAPENTIN","300MG","-360","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","53489011905","DOXYCYCL","100MG","20","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","4","Select","Select",""],["","68180016106","AZITHROMYCIN","500MG","2","Select","Select",""],["","00574220145","TRETINOIN ","0.10%","-45","Select","Select",""],["","70710122600","AMITRIPTYLIN ","25MG","15","Select","Select",""],["","10702005601","OXYCODONE ","10MG","60","Select","Select",""],["","00527150537","AMPHET\/DEXTR ","20MG","60","Select","Select",""],["","00093083205","CLONAZEPAM ","0.5MG","60","Select","Select",""],["","68180052001","LISINOP\/HCTZ ","20-25MG","30","Select","Select",""],["","00228212750","CLONIDINE ","0.1MG","60","Select","Select",""],["","57844012001","ADDERALL ","20MG","60","Select","Select",""],["","68462010530","ONDANSETRON ","4MG","30","Select","Select",""],["","65862050320","AMOX\/K ","875-125","10","Select","Select",""],["","69097012203","TOPIRAMATE ","25MG","60","Select","Select",""],["","42858010401","OXYCOD\/APAP ","10-325MG","90","Select","Select",""],["","69097094312","GABAPENTIN ","300MG","-360","Select","Select",""],["","43598029590","PREGABALIN ","150MG","60","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","16571020106","DICLOFENAC ","75MG DR","60","Select","Select",""],["","00832105410","BACLOFEN ","10MG","360","Select","Select",""],["","53489011905","DOXYCYCL ","100MG","20","Select","Select",""],["","68180016106","AZITHROMYCIN ","500MG","2","Select","Select",""],["","00093310905","AMOXICILLIN ","500MG","24","Select","Select",""],["","24510005010","NUCYNTA ","50MG","100","Select","Select",""],["","88888888887","DMR ","","1","Select","Select",""],["","50111033401","METRONIDAZOL ","500MG","4","Select","Select",""],["","24510005010","NUCYNTA","50MG","100","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}