{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRITTNEY   M WOMACK","gend":1,"add":"252 PARKER RD APT 32","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"1991-05-30","age":"","mstatus":"","insh":"8458626*01","cliId":"","pno":"434\/203-7204","cno":"434\/421-8575","email":"","ename":"","eno":"","pphy":"ADAMS, DAVID MD","ppno":"434\/857-3600","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\/857-3601","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.32","O34.211","Z3A.38","Z37.0","O34.219","O14.93","O76.","Z30.2","O75.82","O99.354","O14.94","O26.893","O99.344","M25.572","Z87.59","Z91.040","Z91.048","Z90.89","Z83.3","Z82.49","O14.90","R09.89","I51.89","Z98.891","M25.311","M25.511","Z47.89","L02.412","Z98.890","R68.84","K04.01","K05.00","M54.2","R51.9","K25.9","R56.9","I50.1","I11.0","R60.0","R94.31","I10.","S02.5XXA","K08.89","R41.82","R00.0","F11.10","I16.0","I50.31","Z34.83","V58.89","N39.0","G40.909","F12.10","T50.904A","R40.20","R09.02","T88.7XXA","I95.9","S02.5XXB","F41.9","F33.3","F12.20","A08.4","O90.89","R03.0","I50.23","E87.70","J96.01","A64.","M24.111","F17.210","G89.18","R06.00","O14.95","O99.355","N17.9","O90.81","E87.79","J45.909","F31.9","G47.00","F12.90","R74.0","E83.42","E87.6","Z79.899","R07.89","K29.00","Z88.8","R06.2","R10.11","R11.0","R94.5","B96.89","B96.20","R07.9","I34.0","I36.1","G50.1","K02.9","R74.01","R10.13","K29.50","K31.9","Z53.21","F32.1","J45.991","O99.332","O99.012","O99.342","Z3A.21","O26.92","O23.41","O99.611","K59.00","Z3A.13","Z34.82","Z23.","Z72.0","Z34.90","O99.351","Z3A.01","Z34.81","O23.42","Z3A.14","Z31.5","O99.353","Z3A.28","Z76.0","Z33.1","O26.93","R10.32","R05.","Z87.891","R10.9","M25.552","Z3A.15","T14.8XXA","F43.10","S13.9XXA","NO DATA","M25.562","M25.561","S00.31XA","Z04.1","H10.30","S13.4XXA","Y09."],"date":["2021-07-20","2020-02-27","2020-02-27","2020-02-27","2020-02-27","2020-02-27","2020-02-27","2020-02-27","2020-02-27","2020-02-27","2020-02-27","2020-02-27","2020-02-27","2020-02-27","2020-02-27","2022-03-14","2020-02-27","2020-02-27","2020-02-27","2020-02-27","2020-03-05","2020-03-05","2020-03-05","2020-03-05","2021-06-11","2020-11-30","2020-11-30","2020-12-02","2021-04-16","2021-11-29","2021-11-29","2021-11-29","2021-11-29","2022-03-14","2021-12-06","2021-12-26","2020-03-10","2020-03-10","2020-03-10","2020-03-10","2020-10-29","2021-09-12","2021-09-12","2021-12-26","2021-12-26","2021-12-26","2020-03-06","2020-03-06","2020-05-25","2020-10-29","2022-03-14","2021-12-26","2021-12-26","2021-12-26","2021-12-26","2021-12-26","2021-12-26","2021-12-26","2020-04-25","2022-03-25","2022-03-25","2022-03-25","2021-05-13","2020-03-03","2020-03-03","2020-03-06","2020-03-06","2020-03-06","2020-09-07","2020-10-29","2021-12-03","2020-10-29","2020-03-03","2020-03-04","2020-03-04","2020-03-04","2020-03-04","2020-03-04","2021-12-03","2020-03-04","2020-03-04","2020-03-04","2020-03-04","2020-03-04","2020-03-04","2021-12-26","2020-05-25","2021-12-03","2022-03-14","2021-12-03","2021-12-05","2021-12-05","2021-12-05","2021-12-26","2021-12-26","2020-03-04","2020-03-04","2020-03-04","2021-11-27","2021-11-28","2021-12-05","2021-12-05","2021-12-06","2021-12-06","2021-12-26","2019-10-27","2019-10-24","2019-10-24","2019-10-24","2019-10-24","2019-10-24","2019-10-24","2019-08-30","2019-08-30","2019-08-30","2019-08-30","2019-10-08","2019-10-08","2019-11-14","2019-11-14","2019-07-31","2019-07-31","2019-08-15","2019-09-18","2019-09-18","2019-12-20","2019-12-20","2019-12-20","2019-09-01","2019-09-01","2019-12-20","2019-12-20","2019-12-20","2019-12-20","2019-12-20","2019-09-20","2019-09-20","2022-01-21","2022-03-25","2022-03-14","2022-03-14","2022-03-14","2022-03-14","2022-01-21","2022-01-21","2022-08-17","2022-03-14","2022-03-14"],"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":[["","","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","55111018601","QUETIAPINE","TAB 100MG","30","Select","Select",""],["","10702000601","CYCLOBENZAPR","TAB 5MG","30","Select","Select",""],["","","AMOXICILLIN","CAP 500MG","","Select","Select",""],["","","ACETAMIN","TAB 500MG","","Select","Select",""],["","00536322201","PAIN","TAB 325MG","50","Select","Select",""],["","13668001990","VENLAFAXINE","CAP 75MG ER","30","Select","Select",""],["","31722053960","LEVETIRACETA","TAB 1000MG","30","Select","Select",""],["","","SMZ-TMP","TAB 800-160","","Select","Select",""],["","","LISINOPRIL","TAB 40MG","","Select","Select",""],["","70010016305","CETIRIZINE","TAB 10MG","10","Select","Select",""],["","","HYDROXYZ","CAP 25MG","","Select","Select",""],["","24208031510","POLYMYXIN","SOL TRIMETHP","10","Select","Select",""],["","","IBUPROFEN","TAB 600MG","","Select","Select",""],["","57237004101","PENICILLN","TAB 500MG","30","Select","Select",""],["","16729016917","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","43199001301","HYOSCYAMINE","TAB 0.125MG","8","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","20","Select","Select",""],["","","NAPROXEN","TAB 500MG","","Select","Select",""],["","50383077504","LIDOCAINE","SOL 2% VISC","100","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","20","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","00254101196","SUCRALFATE","SUS 1GM\/10ML","400","Select","Select",""],["","00143122710","DICYCLOMINE","TAB 20MG","20","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","14","Select","Select",""],["","","APAP\/CODEINE","TAB 300-30MG","","Select","Select",""],["","","METOPROL","TAB 50MG","","Select","Select",""],["","","FUROSEMIDE","TAB 40MG","","Select","Select",""],["","","IBU","TAB 800MG","","Select","Select",""],["","","OXYCODONE","TAB 5MG","","Select","Select",""],["","","STOOL","CAP 100MG","","Select","Select",""],["","","FERROUS","TAB 325MG EC","","Select","Select",""],["","","GABAPENTIN","CAP 100MG","","Select","Select",""],["","59762490004","SERTRALINE","TAB 50MG","30","Select","Select",""],["","","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","20","Select","Select",""],["","","SMZ\/TMP","TAB 800-160","","Select","Select",""],["","00904531360","PRENATAL","TAB 27-0.8MG","30","Select","Select",""],["","11534016503","FOLIC","TAB 1MG","30","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","59310057922","PROAIR","AER ","8","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":""}]}]}