{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHANTE   S JONES","gend":1,"add":"289 PATTESON ST","city":"APPOMATTOX","state":"VA","zip":"24522-9998","dob":"2005-05-23","age":"","mstatus":"","insh":"1019916*01","cliId":"","pno":"000\/000-0000","cno":"","email":"","ename":"","eno":"","pphy":"ZAMORA-SILIEZAR, LUIS MD","ppno":"434\/200-3656","pcpadd":"1901 TATE SPRINGS ROAD","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":"434\/200-3650","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.2","H47.231","H52.03","H52.223","J02.9","R05.","E04.9","Z71.3","F34.81","Z20.822","N89.8","N76.0","J02.0","J06.9","J45.909","Z00.129","E55.9","F41.9","E66.9","E04.1","J45.901","J40.","K21.9","Z91.14","E66.01","R05.9","H10.45","N94.6","F90.2","K59.00","R10.13","J03.01","J34.2","J30.9","G43.809","R07.9","M54.2","R10.9"],"date":["2020-09-17","2021-02-04","2021-02-04","2021-02-04","2020-02-29","2020-02-29","2020-02-29","2020-02-29","2022-01-13","2021-10-20","2022-06-10","2022-06-10","2022-03-08","2020-01-27","2020-01-27","2021-04-30","2021-04-30","2021-09-25","2021-04-30","2021-06-23","2021-08-02","2021-08-02","2021-09-25","2021-09-25","2021-09-25","2022-03-08","2021-02-04","2022-09-28","2020-01-23","2021-10-28","2021-10-28","2020-04-21","2020-04-21","2020-04-21","2020-08-19","2020-08-19","2020-08-19","2021-06-23"],"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":[["","50428026927","MELATONIN","TAB 5MG","30","Select","Select",""],["","59417010410","VYVANSE","CAP 40MG","30","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","20","Select","Select",""],["","42806015905","HYDROXYZ","TAB 10MG","90","Select","Select",""],["","16571040250","CETIRIZINE","TAB 10MG","21","Select","Select",""],["","68462030929","NORGEST\/ETHI","TAB 0.25\/35","28","Select","Select",""],["","11877001140","BINAXNOW","KIT HOME TES","2","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","25","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","50428887847","CVS","TAB 600MG","14","Select","Select",""],["","24208060110","ALAWAY","DRO 0.025%OP","10","Select","Select",""],["","43386031208","GAVILAX","POW ","238","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","18","Select","Select",""],["","00378827052","ALBUTEROL","NEB 0.00083","300","Select","Select",""],["","00603459321","METHYLPRED","TAB 4MG","21","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","00536100901","FERROUS","TAB 325MG","30","Select","Select",""],["","16729020001","BUSPIRONE","TAB 5MG","90","Select","Select",""],["","31604002665","FISH","CAP 1000MG","30","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","21","Select","Select",""],["","13811070810","METHYLPHENID","TAB 36MG ER","30","Select","Select",""],["","65862050220","AMOX\/K","TAB 500-125","30","Select","Select",""],["","50458058601","CONCERTA","TAB 36MG","30","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","30","Select","Select",""],["","63824000832","MUCINEX","TAB 600MG ER","20","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":""}]}]}