{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CAMRON MIZE MUNDIE","gend":1,"add":"54 MONTAGUE TERRACE APT 203","city":"STUARTS DRAFT","state":"VA","zip":"24477-9998","dob":"1975-10-21","age":"","mstatus":"","insh":"2244367*01","cliId":"","pno":"540\/649-0357","cno":"","email":"","ename":"","eno":"","pphy":"BRAWLEY, STEPHEN MD","ppno":"434\/823-7893","pcpadd":"540 RADFORD LN STE 250","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22903,"pcpcounty":"","pcpid":"","pcpname":"AUGUSTA MEDICAL GROUP","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/220-5941","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.5","M54.2","G89.29","M47.812","M48.02","M54.42","M54.41","NO DATA","M54.12","M50.30","N95.0","R19.7","G43.909","G43.809","H53.8","R07.9","R06.02","M50.321","M50.322","M47.892","M47.22","F41.8","M51.37","Z68.30","Z12.39","R13.10","R22.1","R51.9","M79.7","F41.9","F32.9","M53.9","R10.9","R10.31","M79.89","R51.","S90.211A","S00.511A","M51.36","Z00.00","R53.81","A69.20","J01.90"],"date":["2020-06-02","2021-06-02","2020-06-02","2020-12-23","2021-06-02","2021-04-02","2021-04-02","2020-08-05","2020-12-23","2021-06-02","2019-12-12","2019-12-12","2021-12-15","2020-02-21","2020-02-21","2020-08-04","2020-08-04","2020-09-09","2020-09-09","2020-09-09","2021-06-02","2021-12-15","2021-12-15","2021-12-15","2021-12-15","2021-12-15","2021-12-15","2021-04-10","2021-02-19","2021-02-19","2021-02-19","2021-03-16","2021-03-16","2021-03-16","2021-05-12","2020-05-14","2021-04-20","2021-04-20","2021-04-20","2021-11-15","2021-11-15","2021-11-15","2021-11-15"],"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":[["","","CRYSELLE-28"," CRYSELLE-28 ","28","Select","Select",""],["","","SUMATRIPTAN"," SUMATRIPTAN ","9","Select","Select",""],["","","BUPROPN"," BUPROPN ","30","Select","Select",""],["","","CYCLOBENZAPR"," CYCLOBENZAPR ","30","Select","Select",""],["","","TOPIRAMATE"," TOPIRAMATE ","60","Select","Select",""],["","","ASPERCREME","PAD LIDO 4%","","Select","Select",""],["","","MELOXICAM","TAB 15MG","","Select","Select",""],["","","PROMETHAZINE","TAB 25MG","","Select","Select",""],["","","PREDNISONE","TAB 10MG","","Select","Select",""],["","","LIDOCAINE","PAD 0.05","","Select","Select",""],["","","DICLOFENAC","TAB 75MG DR","","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":""}]}]}