{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GERNAYA   K SPENCER","gend":1,"add":"7824 W MARY PAGE LN UNIT 1213","city":"RICHMOND","state":"VA","zip":"23237-9998","dob":"2005-05-20","age":"","mstatus":"","insh":"1019497*01","cliId":"","pno":"804\/986-2790","cno":"804\/971-4689","email":"","ename":"","eno":"","pphy":"BACHRACH, ALEXIS MD","ppno":"804\/897-2134","pcpadd":"SUITE 301 1 PARK WEST CIRCLE","pcpcity":"MIDLOTHIAN","pcpstate":"VA","pcpzip":23114,"pcpcounty":"","pcpid":"","pcpname":"VIRGINIA PHYSICIANS FOR WOMEN LTD","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/897-9076","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.1","F34.81","F32.9","J02.9","Z20.822","F39.","F90.2","F31.9","F33.1","Z30.42","Z30.46","Z30.9","N93.9","Z32.02","F91.3","F41.9","Z20.2"],"date":["2020-08-05","2021-10-22","2022-06-24","2021-12-22","2021-12-22","2020-10-24","2020-06-21","2020-10-24","2021-08-26","2021-09-30","2021-09-30","2021-09-30","2021-09-14","2021-09-14","2020-01-30","2020-01-30","2020-12-04"],"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":[]},{"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":[["","59762305102","AZITHROMYCIN","POW 1GM PAK","1","Select","Select",""],["","59762453802","MEDROXYPR","INJ 150MG\/ML","1","Select","Select",""],["","23155013525","DOXYCYC","TAB 100MG","14","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","20","Select","Select",""],["","60505392801","GUANFACINE","TAB 2MG ER","30","Select","Select",""],["","51991029201","OXCARBAZEPIN","TAB 150MG","60","Select","Select",""],["","69097083412","SERTRALINE","TAB 50MG","30","Select","Select",""],["","50111064801","FLUOXETINE","CAP 20MG","30","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":""}]}]}