{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHARLIE  J NICHOLS","gend":0,"add":"1017 CIRCLE ROAD","city":"BEDFORD","state":"VA","zip":24523,"dob":"1960-02-03","age":"","mstatus":"","insh":"20032758*01","cliId":"","pno":"540\/460-7335","cno":"","email":"","ename":"","eno":"","pphy":"Route,  barbara","ppno":"540\/586-7273","pcpadd":"5424 Discovery Park Blvd BLDB A STE 201","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":24523,"pcpcounty":"","pcpid":"","pcpname":"CENTRA MEDICAL GROUP LLC","plan":"OHP","program":"Medicaid","lob":"OHCC","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/586-2887","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M75.42","Z23.","M48.02","M99.81","M50.30","Z68.30","E11.9","E78.00","M19.90","M54.2","R05.","W57.XXXA","R63.4","J30.2","R61.","J01.00","M75.00","M25.512","N52.9","Z78.9","M75.82","J06.9","R51.","M15.9","R39.9"],"date":["2021-01-26","2021-12-16","2020-11-13","2020-11-13","2020-11-13","2020-06-10","2021-12-16","2021-12-16","2020-06-11","2019-05-08","2019-05-08","2019-05-08","2019-05-08","2019-05-08","2019-05-08","2019-05-08","2020-11-13","2020-10-15","2021-12-16","2020-06-10","2019-11-13","2019-01-28","2020-06-11","2020-06-11","2022-11-01"],"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":[["","","PRAVASTATIN"," PRAVASTATIN ","30","Select","Select",""],["","","METFORMIN"," METFORMIN ","180","Select","Select",""],["","","JARDIANCE","TAB 10MG","","Select","Select",""],["","","ONETOUCH"," ONETOUCH ","300","Select","Select",""],["","00832105410","BACLOFEN","TAB 10MG","90","Select","Select",""],["","","DOXAZOSIN"," DOXAZOSIN ","30","Select","Select",""],["","","JANUVIA"," JANUVIA ","30","Select","Select",""],["","","AMITRIPTYLIN"," AMITRIPTYLIN ","30","Select","Select",""],["","16571066101","MECLIZINE","TAB 25MG","60","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","43386048024","ORPHENADRINE","TAB 100MG ER","60","Select","Select",""],["","","PREDNISONE","TAB 20MG","","Select","Select",""],["","60505384901","CELECOXIB","CAP 200MG","90","Select","Select",""],["","","DICLOFENAC","TAB 75MG DR","","Select","Select",""],["","00093834410","GLYBURIDE","TAB 5MG","60","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","65862068890","SILDENAFIL","TAB 20MG","90","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","60","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":""}]}]}