{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KANIYAH   D FITZGERALD","gend":1,"add":"631 PARK AVE","city":"DANVILLE","state":"VA","zip":"24541-9998","dob":"2002-12-28","age":"","mstatus":"","insh":"1401128*01","cliId":"","pno":"336\/539-4865","cno":"","email":"","ename":"","eno":"","pphy":"BEACH, JACOB NP","ppno":"434\/857-3600","pcpadd":"414 PARK AVE","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"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\/857-3601","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.5","M62.830","R10.13","Z87.19","Z30.42","R13.19","R11.0","R10.9","K59.01","Z01.89","Z01.810","Z01.812","H10.413","K22.2","K21.9","K29.60","Z20.822","I15.8","R51.9","K29.00","R11.2","N89.8","K82.9","K59.09","J02.0","J02.9","J45.909","F32.9","NO DATA","Z72.0","E66.9","R06.2","Z20.828","R05.9","F41.1","F90.2","K29.50","F33.1","F41.9","H10.13","M79.676","R25.2","S80.02XA","W23.0XXA"],"date":["2021-01-07","2021-01-07","2021-03-30","2021-04-21","2020-08-04","2020-12-04","2021-03-17","2021-03-17","2021-03-17","2020-11-23","2020-12-01","2020-12-01","2021-01-06","2021-03-17","2021-12-23","2021-03-17","2021-06-22","2021-08-20","2021-08-20","2020-03-05","2020-03-05","2020-08-06","2021-03-17","2021-04-21","2021-10-27","2021-10-27","2021-12-23","2021-12-23","2021-12-23","2021-12-23","2021-12-23","2021-06-22","2021-05-19","2021-11-29","2021-03-10","2021-03-10","2020-12-04","2021-03-10","2019-06-25","2019-03-25","2019-12-23","2019-11-05","2019-04-24","2019-04-24"],"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":[["","68462019005","NAPROXEN","TAB 500MG","20","Select","Select",""],["","00378427577","VALACYCLOVIR","TAB 500MG","30","Select","Select",""],["","00378668999","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","00591079501","DICYCLOMINE","TAB 20MG","60","Select","Select",""],["","13811064701","MECLIZINE","TAB 25MG","30","Select","Select",""],["","61783000012","FC2","MIS CONDOM","96","Select","Select",""],["","00378870006","ACYCLOVIR","OIN 0.05","15","Select","Select",""],["","65862094088","AUROVELA","TAB 43831","28","Select","Select",""],["","00574110416","BROM\/PSE\/DM","SYP ","200","Select","Select",""],["","83490031065","VIOS","MIS SYSTEM","1","Select","Select",""],["","50111064801","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","66685100100","AMOX\/K","TAB 875-125","14","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","23155050001","HYDROXYZ","TAB 10MG","60","Select","Select",""],["","59762040101","SUCRALFATE","TAB 1GM","60","Select","Select",""],["","00093768432","OLOPATADINE","SOL 0.002","2","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","20","Select","Select",""],["","60505265301","TRAZODONE","TAB 50MG","60","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","65862017760","CEFDINIR","CAP 300MG","20","Select","Select",""],["","50111078751","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00054001925","PREDNISONE","TAB 50MG","5","Select","Select",""],["","70700016406","LEVONORGESTR","TAB 1.5MG","8","Select","Select",""],["","59762453701","MEDROXYPR","INJ 150MG\/ML","1","Select","Select",""],["","10702002501","PHENTERMINE","TAB 37.5MG","30","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":""}]}]}