{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"F ANAITSREWOL","gend":1,"add":"C YDARG 88B TPA SER","city":"CHESAPEAKE","state":"VA","zip":"23324-9998","dob":"1998-06-29","age":"","mstatus":"","insh":"2505410*93","cliId":"","pno":"33\/7576357-4","cno":"","email":"","ename":"","eno":"","pphy":"PASCIONI, ALEXA S MD","ppno":"757\/466-6350","pcpadd":"880 KEMPSVILLE ROAD SUITE 2200","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23502,"pcpcounty":"","pcpid":"","pcpname":"MAWC - The Group for Women","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J02.9","R05.","Z20.828","Z87.891","O26.893","R10.9","Z3A.38","Z38.00","Z28.21","F32.9","Z30.45","Z01.411","Z11.3","N89.8","J06.9","O80.","Z3A.39","Z37.0","N76.0","B96.89","Z30.40","Z32.02","F43.21","R30.0","Z30.09","O26.92","R22.0","Z3A.27","B36.0","B36.8","L21.8","L20.84","R11.2","Z33.1","Z30.011","R21.","F17.210","L02.31","O99.282","O99.513","Z3A.00","L21.9","Z71.9","O20.0","R07.9","Z23.","Z36.9","Z39.2","Z13.31","F33.1","S06.0X0A","S29.012A","N39.0","R39.15","O47.03","O42.02","O71.89","N30.00","O20.9","O02.81","O26.849","Z32.01","N93.8","Z36.89","O26.891","R52.","Z3A.11"],"date":["2020-04-02","2020-04-02","2020-05-26","2020-04-02","2020-05-22","2020-05-22","2020-05-22","2020-05-27","2020-05-27","2021-05-07","2021-05-07","2021-05-07","2021-05-07","2021-05-07","2021-07-14","2020-05-27","2020-05-27","2020-05-27","2020-11-23","2020-11-23","2021-03-18","2021-09-24","2021-03-24","2019-05-15","2019-05-15","2020-03-04","2020-03-04","2020-03-04","2020-08-21","2020-08-21","2020-08-21","2020-08-21","2019-10-12","2019-10-12","2019-09-17","2019-09-22","2019-09-22","2020-02-13","2020-03-04","2020-04-02","2021-10-13","2021-03-31","2021-03-31","2021-10-13","2019-07-21","2020-03-10","2020-03-10","2020-07-16","2020-07-16","2021-03-08","2021-06-04","2021-06-04","2021-09-23","2021-09-24","2020-05-22","2020-05-26","2020-05-26","2021-04-13","2021-12-08","2021-10-13","2021-12-08","2021-12-08","2019-07-23","2019-10-17","2019-11-15","2019-11-15","2019-11-15"],"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":[["","","XULANE"," XULANE ","9","Select","Select",""],["","","FLUCONAZOLE"," FLUCONAZOLE ","1","Select","Select",""],["","72578008602","DESONIDE","CRE 0.0005","60","Select","Select",""],["","51862056406","LOW-OGESTREL","TAB ","28","Select","Select",""],["","67877021560","CEFUROXIME","TAB 250MG","20","Select","Select",""],["","69097083412","SERTRALINE","TAB 50MG","30","Select","Select",""],["","13668001005","CITALOPRAM","TAB 20MG","90","Select","Select",""],["","","IBUPROFEN","TAB 800MG","","Select","Select",""],["","","METRONIDAZOL"," METRONIDAZOL ","14","Select","Select",""],["","00603533815","PREDNISONE","PAK 10MG","21","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","21","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","51672135708","FLUOCIN","OIL 0.01% SC","118","Select","Select",""],["","44523056008","SOD","LIQ 10-5%","227","Select","Select",""],["","13668013601","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","76385012350","METHOCARBAM","TAB 500MG","40","Select","Select",""],["","","IRON","TAB 325MG","","Select","Select",""],["","","PIMECROLIMUS","CRE 0.01","","Select","Select",""],["","","MONO-LINYAH","TAB 0.25-35","","Select","Select",""],["","","AMOX\/K","TAB 875-125","","Select","Select",""],["","","DOK","CAP 100MG","","Select","Select",""],["","","FERROUS","TAB 325MG","","Select","Select",""],["","","OXYCOD\/APAP","TAB 7.5-325","","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":""}]}]}