{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  ADNAHSALYNOHTNA S ","gend":1,"add":"WDAORB W 77051A TPA YAW RETA","city":"CHESTER","state":"VA","zip":"23831-9998","dob":"1987-12-02","age":"","mstatus":"","insh":"96300210*97","cliId":"","pno":"23\/8763716-2","cno":"678\/322-6173","email":"","ename":"","eno":"","pphy":"GIBSON-NEALE, JANICE L MD","ppno":"804\/231-9691","pcpadd":"SUITE 208 101 COWARDIN AVE","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23224,"pcpcounty":"","pcpid":"","pcpname":"Virginia Complete Care for Women","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","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":["F31.31","F41.1","F33.2","F31.81","F43.10","Z20.828","J02.9","U07.1","R51.9","R05.","S93.402A","W18.40XA","J20.9","J10.1","Z20.822","K52.9","R19.7","Z01.419","Z11.3","N83.209","Z30.41","N87.0","R87.612","Z32.02","N83.201","Z30.09","S16.1XXA","S39.012A","S70.02XA","N92.6","J06.9","R10.2","Z30.46","Z30.011","H10.9"],"date":["2020-05-25","2022-01-03","2020-07-31","2022-01-03","2022-01-03","2021-01-07","2020-11-18","2020-12-24","2020-12-24","2020-12-24","2021-06-14","2021-06-14","2022-11-08","2022-11-08","2022-11-08","2020-02-28","2020-02-28","2022-02-09","2022-02-09","2022-02-09","2022-02-09","2022-02-09","2020-10-06","2020-10-06","2020-10-22","2020-10-06","2021-03-12","2021-03-12","2021-03-12","2021-08-27","2020-04-11","2020-09-29","2020-10-15","2020-10-15","2021-11-19"],"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":[]},{"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":[["","00378728353","NORETH\/ETHIN","TAB FE 1\/20","28","Select","Select",""],["","16729016801","ESCITALOPRAM","TAB 5MG","30","Select","Select",""],["","00093506101","HYDROXYZ","TAB 25MG","60","Select","Select",""],["","55111053301","DIVALPROEX","TAB 250MG ER","30","Select","Select",""],["","82607066026","FLOWFLEX","KIT TEST","8","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","21","Select","Select",""],["","73302045601","ELLA","TAB 30MG","2","Select","Select",""],["","61783000012","FC2","MIS CONDOM","96","Select","Select",""],["","64380071206","BENZONATATE","CAP 100MG","15","Select","Select",""],["","16714040604","LARIN","TAB 44581","28","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","65162019010","NAPROXEN","TAB 500MG","20","Select","Select",""],["","65862019105","CYCLOBENZAPR","TAB 10MG","20","Select","Select",""],["","16571020210","DICLOFENAC","TAB 50MG DR","20","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","61314062810","POLYMYXIN","SOL TRIMETHP","10","Select","Select",""],["","00378623201","CITALOPRAM","TAB 20MG","30","Select","Select",""],["","00591024005","LORAZEPAM","TAB 0.5MG","30","Select","Select",""],["","64380078706","BUSPIRONE","TAB 7.5MG","60","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","49281072010","FLUBLOK","INJ 2020-21","0","Select","Select",""],["","70461032003","FLUCLVX","INJ 2020-21","0","Select","Select",""],["","49281042050","FLUZONE","INJ 2020-21","0","Select","Select",""],["","33332042010","AFLURIA","INJ 2020-21","0","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":""}]}]}