{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"W   REBMADOOWRON ","gend":1,"add":"LYS 7023LP AINAV","city":"CHESTER","state":"VA","zip":"23831-9998","dob":"1990-12-31","age":"","mstatus":"","insh":"0056110*41","cliId":"","pno":"93\/4084729-7","cno":"","email":"","ename":"","eno":"","pphy":"COOK, LAUREN NP","ppno":"804\/897-2100","pcpadd":"10710 MIDLOTHIAN TPKE STE 200","pcpcity":"NORTH CHESTERFIELD","pcpstate":"VA","pcpzip":23235,"pcpcounty":"","pcpid":"","pcpname":"Virginia Physicians for Women","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z20.828","L23.7","M43.10","M51.26","M53.3","M54.17","G89.29","F43.20","M54.5","M43.00","Z01.419","Z11.3","Z11.51","Z30.09","Z80.49","V54.16","F41.1","M79.672","Z20.822","F33.1","R11.10","S92.332A","M62.830","M43.17","N30.00","Z30.41","R50.9","J02.9","Z68.26","M53.88"],"date":["2021-01-21","2020-06-14","2021-09-21","2021-09-21","2021-09-21","2021-09-21","2021-09-21","2021-07-06","2021-07-01","2021-07-01","2021-07-01","2021-07-01","2021-07-01","2021-07-01","2021-07-01","2020-07-20","2021-03-13","2020-06-16","2021-10-20","2021-10-15","2020-05-22","2020-06-10","2021-09-21","2019-02-19","2019-11-13","2019-11-13","2019-12-17","2019-12-17","2019-12-17","2019-02-04"],"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":[["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","90","Select","Select",""],["","","PREDNISONE","PAK 10MG","","Select","Select",""],["","69097084805","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","59417010310","VYVANSE","CAP 30MG","30","Select","Select",""],["","61442010210","DICLOFENAC","TAB 50MG DR","14","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","10702000350","PROMETHAZINE","TAB 25MG","12","Select","Select",""],["","00406012405","HYDROCO\/APAP","TAB 7.5-325","6","Select","Select",""],["","","HYDROXYZ","TAB 25MG","","Select","Select",""],["","68462072029","DROSPIRENONE","TAB ETHY EST","28","Select","Select",""],["","","YAZ","TAB 3-0.02MG","","Select","Select",""],["","","TRIAMCINOLON","CRE 0.001","","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","30","Select","Select",""],["","00781565615","LORYNA","TAB 3-0.02MG","28","Select","Select",""],["","29300012510","MELOXICAM","TAB 15MG","30","Select","Select",""],["","65862064169","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","68180088613","NIKKI","TAB 3-0.02MG","28","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","6","Select","Select",""],["","59762500801","MISOPROSTOL","TAB 200MCG","4","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":""}]}]}