{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AUDREY MEISNER","gend":1,"add":"PO BOX 3323","city":"LYNCHBURG","state":"VA","zip":"24503-9998","dob":"1969-03-29","age":"","mstatus":"","insh":"20015466*01","cliId":"","pno":"434\/401-1029","cno":"","email":"","ename":"","eno":"","pphy":"MAHNE, OLENA Z NP","ppno":"434\/200-3908","pcpadd":"125 NATIONWIDE DRIVE","pcpcity":"LYNCHBURG","pcpstate":"VA","pcpzip":24503,"pcpcounty":"","pcpid":"","pcpname":"CENTRA MEDICAL GROUP LLC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/200-1677","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25.571","V54.16","D64.9","N17.9","R55.","I95.1","S09.8XXA","E87.1","E83.110","I10.","D05.12","R07.81","K92.2","Z09.","V58.89","M54.16","R53.1","R26.2","K44.9","K29.50","K31.89","D50.0","R19.5","Z71.83","L71.9","T78.40XA","R42.","E78.00","D37.5","D12.5","K57.30","Z76.89","K21.9","E78.5","R79.0","N28.9","M54.17","NO DATA","D62.","Z71.9","M18.12","M79.642","S06.0X9A","S40.011A","E86.0","R11.2","Z85.3","Z79.899","Z79.810","Z88.0","Z88.1","Z87.891","S82.831A","H00.019","S93.492A","M25.572","I12.9","N18.4","R53.83","E83.119","T78.3XXA","Z71.89"],"date":["2019-12-11","2019-12-11","2021-12-17","2020-11-11","2020-12-03","2020-10-30","2020-10-30","2020-10-30","2021-11-30","2021-11-30","2021-07-19","2020-04-28","2020-05-28","2020-11-06","2019-08-01","2019-05-01","2019-05-01","2019-05-01","2020-05-22","2020-05-22","2020-05-22","2020-05-22","2020-05-22","2021-01-25","2019-04-04","2019-04-04","2020-02-12","2019-04-04","2020-03-27","2020-03-27","2020-03-27","2021-11-30","2021-11-30","2021-11-30","2021-11-30","2021-11-30","2019-02-01","2019-04-16","2020-03-18","2020-03-18","2020-09-08","2020-09-08","2020-10-29","2020-10-29","2020-10-29","2020-10-29","2020-10-29","2020-10-29","2020-10-29","2020-10-29","2020-10-29","2020-10-29","2019-10-07","2019-04-12","2019-07-18","2019-07-18","2021-12-17","2021-12-17","2020-02-12","2020-03-17","2021-04-02","2021-04-02"],"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":[["","","TAMOXIFEN"," TAMOXIFEN ","30","Select","Select",""],["","","DICLOFENAC"," DICLOFENAC ","60","Select","Select",""],["","10702003645","SOD","POW ","454","Select","Select",""],["","","ATENOLOL"," ATENOLOL ","30","Select","Select",""],["","","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","49502010202","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","","VITAMIN","CAP 50000UNT","","Select","Select",""],["","","HYDROCHLOROT","TAB 25MG","","Select","Select",""],["","","GAVILYTE-G","SOL ","","Select","Select",""],["","","PEG-3350","SOL ELECTROL","","Select","Select",""],["","","EPIPEN","INJ 0.3MG","","Select","Select",""],["","","SUPREP","SOL PREP KIT","","Select","Select",""],["","","CETIRIZINE","TAB 10MG","","Select","Select",""],["","","IBUPROFEN","TAB 800MG","","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":""}]}]}