{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VIRGINIA  F LAYNE","gend":1,"add":"102 JOHN RANDOLPH ROAD","city":"FARMVILLE","state":"VA","zip":23901,"dob":"1949-10-17","age":"","mstatus":"","insh":"20030972*01","cliId":"","pno":"434\/808-3188","cno":"","email":"","ename":"","eno":"","pphy":"Route,  barbara","ppno":"434\/315-5360","pcpadd":"5424 Discovery Park Blvd BLDB A STE 201","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23901,"pcpcounty":"","pcpid":"","pcpname":"CENTRA MEDICAL GROUP LLC","plan":"OHP","program":"Medicaid","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/315-2930","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","R22.32","M79.601","T14.8XXA","M25.552","M25.512","M19.90","M54.2","M54.16","M79.605","M16.12","R60.0","M79.662","E11.9","I73.9","Z95.5","Z87.891","E78.5","M25.511","Z95.828","M54.32","I25.2","M54.5","H53.8","Z79.82","Z79.84","Z88.1","Z88.5","Z95.1","L02.821","M79.89","Z01.818","I70.212","Z77.22","R05.","Z79.02","Z00.00","Z71.89","Z71.3","Z12.31","Z12.11","D12.3","D12.5","K64.1","K57.30","Z98.890","I77.1","D68.9","R29.6","M25.531","M79.641","M79.604","R09.89","I25.10","Z72.0"],"date":["2022-09-14","2020-12-18","2021-11-30","2021-11-30","2021-04-16","2020-01-27","2020-07-17","2020-01-27","2021-04-22","2022-02-18","2020-07-17","2020-07-17","2021-04-13","2022-06-13","2022-09-14","2021-05-03","2021-05-03","2022-09-14","2021-02-18","2020-05-15","2020-07-17","2020-07-17","2021-04-13","2020-09-30","2020-11-19","2020-11-19","2020-11-19","2020-11-19","2020-11-19","2020-02-24","2021-04-16","2019-01-22","2019-07-19","2019-02-04","2019-02-04","2019-02-04","2019-01-15","2019-01-15","2019-01-15","2019-01-15","2019-05-10","2019-05-10","2019-05-10","2019-05-10","2019-05-10","2019-02-19","2019-02-04","2019-07-19","2019-07-19","2022-06-13","2022-06-13","2022-02-18","2022-02-18","2022-09-14","2022-09-14"],"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":[["","68645051654","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","68645055154","LISINOPRIL","TAB 5MG","30","Select","Select",""],["","","TRAMADOL","TAB 50MG","","Select","Select",""],["","68645049554","ATORVASTATIN","TAB 80MG","30","Select","Select",""],["","57237010099","METOPROL","TAB 25MG","60","Select","Select",""],["","","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","","FLUOCINONIDE","SOL 0.0005","","Select","Select",""],["","68645053959","METFORMIN","TAB 500MG","60","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","56","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","30","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","20","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","20","Select","Select",""],["","","PREDNISONE","TAB 20MG","","Select","Select",""],["","","DOXYCYC","CAP 100MG","","Select","Select",""],["","","NAPROXEN","TAB 500MG","","Select","Select",""],["","00168014630","HYDROCORT","OIN 0.025","28","Select","Select",""],["","64380076921","PEG-3350\/KCL","SOL \/SODIUM","4000","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}