{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"FAYE   Y PAIGE","gend":1,"add":"112 HARRISON ST APT 4","city":"LYNCHBURG","state":"VA","zip":"24504-9998","dob":"1957-05-24","age":"","mstatus":"","insh":"20033032*01","cliId":"","pno":"434\/444-8535","cno":"","email":"","ename":"","eno":"","pphy":"GIBBS, PETER DO","ppno":"434\/200-3908","pcpadd":"2323 MEMORIAL AVE","pcpcity":"LYNCHBURG","pcpstate":"VA","pcpzip":24502,"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\/200-5948","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M20.41","M20.42","L60.0","M79.674","M79.675","M25.512","M17.0","M54.17","M79.7","J20.9","M16.0","M25.511","I10.","Z72.0","E66.01","Z79.899","G89.4","M47.22","M54.2","M25.561","M17.11","M54.12","R06.2","H65.90","NO DATA","Z23.","G47.00","E78.5","K21.9","J30.2","K59.00","E55.9","M54.5","M54.16","M47.816","M51.36","J30.9","M54.9","Z20.828","S89.91XA","S70.01XA","K58.9","R19.7","R05.","F41.9","Z71.6","M47.26","J22.","J01.90","A08.4","J45.991"],"date":["2019-11-05","2019-11-05","2019-11-05","2019-11-05","2019-11-05","2021-11-24","2021-10-27","2021-06-24","2021-10-27","2019-09-29","2021-10-27","2021-12-27","2021-11-11","2021-03-29","2021-03-29","2021-06-24","2021-11-24","2021-06-24","2021-09-27","2021-11-24","2021-02-24","2021-12-27","2019-01-22","2019-09-27","2021-10-14","2019-12-09","2021-03-29","2021-11-11","2021-03-29","2021-03-29","2021-11-11","2021-11-11","2019-07-05","2019-07-05","2021-10-14","2021-10-14","2020-05-19","2019-03-29","2020-07-10","2020-12-11","2020-12-11","2019-01-15","2019-01-15","2020-09-04","2019-02-01","2019-10-11","2021-07-26","2020-07-10","2020-09-04","2019-01-04","2019-01-04"],"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":[["","","DICYCLOMINE"," DICYCLOMINE ","200","Select","Select",""],["","","PREDNISONE"," PREDNISONE ","10","Select","Select",""],["","","SERTRALINE"," SERTRALINE ","30","Select","Select",""],["","","OMEPRAZOLE"," OMEPRAZOLE ","90","Select","Select",""],["","","AZITHROMYCIN"," AZITHROMYCIN ","6","Select","Select",""],["","","PROVENTIL"," PROVENTIL ","7","Select","Select",""],["","","ATORVASTATIN"," ATORVASTATIN ","30","Select","Select",""],["","","BUPROPION"," BUPROPION ","60","Select","Select",""],["","","VITAMIN"," VITAMIN ","30","Select","Select",""],["","","LOSARTAN"," LOSARTAN ","30","Select","Select",""],["","","ALBUTEROL"," ALBUTEROL ","8","Select","Select",""],["","","TRAMADOL"," TRAMADOL ","60","Select","Select",""],["","","PROAIR"," PROAIR ","8","Select","Select",""],["","","NAPROXEN"," NAPROXEN ","60","Select","Select",""],["","","ALLERGY"," ALLERGY ","30","Select","Select",""],["","","FLUTICASONE"," FLUTICASONE ","16","Select","Select",""],["","","GABAPENTIN"," GABAPENTIN ","60","Select","Select",""],["","","PROMETHAZINE"," PROMETHAZINE ","120","Select","Select",""],["","","CYCLOBENZAPR"," CYCLOBENZAPR ","30","Select","Select",""],["","","MORPHINE"," MORPHINE ","120","Select","Select",""],["","","IBUPROFEN"," IBUPROFEN ","42","Select","Select",""],["","","CARVEDILOL","TAB 6.25MG","","Select","Select",""],["","","AMLODIPINE","TAB 5MG","","Select","Select",""],["","","CVS","CAP 2000UNIT","","Select","Select",""],["","","OXYCODONE","TAB 15MG","","Select","Select",""],["","","BLOOD","KIT 3 SERIES","","Select","Select",""],["","","SERIES","MIS BLOOD PR","","Select","Select",""],["","","SEV","TAB SINUS","","Select","Select",""],["","","CEFDINIR","CAP 300MG","","Select","Select",""],["","","BROM\/PSE\/DM","SYP ","","Select","Select",""],["","","OXYCOD\/APAP","TAB 5-325MG","","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":""}]}]}