{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"FLORETTA   M COLES","gend":1,"add":"1028 GILBERT ST APT 1","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"1983-02-04","age":"","mstatus":"","insh":"7372116*01","cliId":"","pno":"434\/688-1779","cno":"","email":"","ename":"","eno":"","pphy":"SIEGE, KAREN PA","ppno":"434\/200-7210","pcpadd":"414 PARK AVE","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":"","pcpname":"CENTRA MEDICAL GROUP LLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/200-7211","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R30.0","N89.8","N76.0","V54.12","R10.30","R07.9","J06.9","R50.9","Z20.828","J02.9","M79.641","S62.346A","R10.2","R35.0","N39.0","J20.9","Z72.0","R10.9","M94.0","S62.316A","W22.8XXA","R05.","M79.671","R10.84","R11.2","R10.13","R05.9"],"date":["2021-11-12","2021-11-12","2021-11-12","2021-03-16","2021-11-16","2021-08-03","2021-10-26","2021-08-09","2021-08-09","2021-10-26","2021-02-16","2021-02-16","2021-11-16","2021-10-11","2021-10-11","2021-11-06","2021-11-06","2021-11-16","2021-08-02","2021-02-16","2021-02-16","2021-09-07","2021-09-30","2019-03-21","2019-08-30","2019-08-30","2021-10-26"],"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":[["","61442010310","DICLOFENAC","TAB 75MG DR","28","Select","Select",""],["","69097015812","MELOXICAM","TAB 7.5MG","14","Select","Select",""],["","00527193206","CLARITHROMYC","TAB 500MG","14","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","14","Select","Select",""],["","00143980350","DOXYCYCL","CAP 100MG","14","Select","Select",""],["","70436015541","PROMETHAZINE","SOL DM","120","Select","Select",""],["","16571066450","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","67877029605","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","","CLINDAMYCIN","CRE 2% VAG","","Select","Select",""],["","00527128210","DICYCLOMINE","TAB 20MG","20","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","12","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":""}]}]}