{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CARLISSIA   R RUSSELL-COLEMAN","gend":1,"add":"3007 WESTOVER DR APT A","city":"DANVILLE","state":"VA","zip":"24541-9998","dob":"1990-11-19","age":"","mstatus":"","insh":"1378922*01","cliId":"","pno":"434\/334-1435","cno":"","email":"","ename":"","eno":"","pphy":"FALGUI, VICENTE MD","ppno":"434\/791-4648","pcpadd":"212 SOUTH MAIN STREET SUITE 3","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":"","pcpname":"VICENTE T FALGUI MD PC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/793-2631","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E87.6","J10.1","K42.9","I10.","N76.0","B96.89","E66.01","L40.9","H66.93","E53.8","F33.9","R51.","K42.0","E66.9","Z68.42","K21.9","Z91.040","Z91.013","Z20.828","Z30.433","R11.0","R61.","J30.9","R06.02","R20.2","R52.","N39.0","B37.3","E88.81","J30.2"],"date":["2020-03-05","2020-03-05","2021-11-01","2021-07-22","2020-04-20","2020-04-20","2020-10-15","2020-04-20","2020-04-20","2020-10-15","2020-09-17","2020-09-17","2021-11-01","2021-11-01","2021-11-01","2021-11-01","2021-11-01","2021-11-01","2021-08-14","2020-11-18","2020-03-05","2020-03-05","2020-07-13","2021-08-14","2021-08-14","2021-08-14","2019-06-14","2019-06-14","2019-06-03","2019-06-03"],"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":[["","","SAXENDA","INJ 18MG\/3ML","","Select","Select",""],["","10702002501","PHENTERMINE","TAB 37.5MG","30","Select","Select",""],["","68382013905","TOPIRAMATE","TAB 50MG","30","Select","Select",""],["","","FEROSUL","TAB 325MG","","Select","Select",""],["","00781618667","CIPRO\/DEXA","SUS 0.3-0.1%","8","Select","Select",""],["","","CIPRODEX","SUS 0.3-0.1%","","Select","Select",""],["","68382079101","ACYCLOVIR","TAB 400MG","14","Select","Select",""],["","51672125903","CLOBETASOL","OIN 0.0005","60","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","00168009930","KETOCONAZOLE","CRE 0.02","30","Select","Select",""],["","33342008745","RIZATRIPTAN","TAB 5MG","14","Select","Select",""],["","65862041901","SMZ-TMP","TAB 400-80MG","14","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","","VITAMIN","CAP 50000UNT","","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","21","Select","Select",""],["","68180016106","AZITHROMYCIN","TAB 500MG","10","Select","Select",""],["","11917009215","FERROUS","TAB 325MG","30","Select","Select",""],["","08290320550","BD  PEN NEEDL","MIS 32GX5\/32","100","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","29300012810","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","","BROM\/PSE\/DM","SYP ","","Select","Select",""],["","","CYANOCOBALAM","INJ 1000MCG","","Select","Select",""],["","","LEVOCETIRIZI","TAB 5MG","","Select","Select",""],["","","QSYMIA","CAP 3.75-23","","Select","Select",""],["","","XYZAL","TAB 5MG","","Select","Select",""],["","","DICYCLOMINE","TAB 20MG","","Select","Select",""],["","","ONDANSETRON","TAB 8MG","","Select","Select",""],["","","POT  CL MICRO","TAB 20MEQ ER","","Select","Select",""],["","","NYSTAT\/TRIAM","CRE ","","Select","Select",""],["","","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","","BUPROPION","TAB 75MG","","Select","Select",""],["","62856052960","BELVIQ","TAB 10MG","30","Select","Select",""],["","47781030301","NITROFURANTN","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":""}]}]}