{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"REGINA   M WILSON","gend":1,"add":"294 SUGAR HILL ROAD","city":"KENBRIDGE","state":"VA","zip":"23944-9998","dob":"1985-07-02","age":"","mstatus":"","insh":"1285477*01","cliId":"","pno":"804\/467-5367","cno":"","email":"","ename":"","eno":"","pphy":"CHEEMA, RAZA MD","ppno":"434\/767-5511","pcpadd":"412 NAMOZINE ST","pcpcity":"BURKEVILLE","pcpstate":"VA","pcpzip":"23922","pcpcounty":"","pcpid":"","pcpname":"CENTRA MEDICAL GROUP LLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/767-2659","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.0","F41.1","N61.0","Z78.9","L73.2","L90.5","F41.9","Z11.59","R09.81","R19.7","Z20.828","K50.90","R10.9","Z23.","L08.0","U07.1","NO DATA","R06.00","Z86.19","K59.00","R11.0","G43.909","G47.9","L88.","L70.0","L98.8","L85.3","Z87.2","Z01.419","R51.","F41.8","F32.9","R50.9","R11.2","L03.90","K21.9","J30.9","B34.9"],"date":["2020-05-15","2020-04-04","2020-06-30","2020-06-30","2021-10-22","2021-10-22","2020-08-17","2021-04-21","2021-09-28","2021-09-28","2021-09-28","2021-08-31","2020-03-16","2021-08-31","2020-10-13","2021-05-07","2021-05-07","2021-05-26","2021-05-26","2021-08-31","2020-10-13","2020-11-25","2020-11-25","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2021-04-01","2020-05-15","2020-05-15","2020-08-17","2020-05-16","2020-06-07","2020-05-16","2020-06-30","2020-06-30","2021-04-28"],"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":[["","60219107601","AZATHIOPRINE","TAB 50MG","60","Select","Select",""],["","16729018201","HYDROCHLOROT","TAB 12.5MG","90","Select","Select",""],["","42806054701","VITAMIN","CAP 1.25MG","13","Select","Select",""],["","00472011720","TRETINOIN","CRE 0.00025","20","Select","Select",""],["","50111078867","AZITHROMYCIN","TAB 500MG","3","Select","Select",""],["","00135061101","TUMS","CHW 500MG","30","Select","Select",""],["","68682010510","NIFEDIPINE","TAB 30MG ER","30","Select","Select",""],["","68180085473","LEVONOR\/ETHI","TAB 0.1-0.02","28","Select","Select",""],["","21922000201","CLINDAMYCIN","SOL 0.01","60","Select","Select",""],["","64980028203","MESALAMINE","SUP 1000MG","60","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","00074055402","HUMIRA","INJ 40\/0.4ML","4","Select","Select",""],["","55111014512","FLUCONAZOLE","TAB 150MG","4","Select","Select",""],["","69543025216","VIRTUSSIN","SOL 100-10\/5","60","Select","Select",""],["","45802005911","NYSTATIN","CRE 100000","30","Select","Select",""],["","00781286810","OMEPRAZOLE","CAP 20MG","90","Select","Select",""],["","55111015330","ONDANSETRON","TAB 4MG","10","Select","Select",""],["","68645056354","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","13668001001","CITALOPRAM","TAB 20MG","90","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","6","Select","Select",""],["","69238110002","DOXYCYCL","CAP 100MG","60","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","45802005535","TRIAMCINOLON","OIN 0.001","60","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","16714008310","HYDROXYZ","TAB 50MG","40","Select","Select",""],["","61748009230","PYRIDOXINE","TAB 25MG","30","Select","Select",""],["","00115164501","NITROFUR","CAP 100MG","10","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":""}]}]}