{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JADA ROGERS","gend":1,"add":"617 N LABURNUM AVE APT 2","city":"RICHMOND","state":"VA","zip":"23223-9998","dob":"2003-09-23","age":"","mstatus":"","insh":"2084234*01","cliId":"","pno":"804\/605-7683","cno":"","email":"","ename":"","eno":"","pphy":"DOGAL, NATALIE MD","ppno":"804\/897-2100","pcpadd":"7605 FOREST AVE STE 206","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23229,"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":"804\/897-9074","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B37.0","Z30.017","Z30.09","Z30.46","J11.1","K29.70","R51.","R10.9","Z01.818","Z97.5","Z20.822","K29.00","R11.2","S86.911A","X50.1XXA","Y92.000","Z01.419","Z11.3","N76.0","N76.6","Z30.016","R51.9","Z30.49"],"date":["2020-02-06","2020-09-11","2020-09-11","2021-04-15","2020-01-31","2020-07-25","2020-07-25","2020-07-25","2021-05-06","2021-05-06","2021-06-20","2020-12-11","2020-12-11","2019-01-12","2019-01-12","2019-01-12","2021-12-16","2021-12-16","2021-08-09","2021-12-16","2021-12-16","2021-03-19","2021-05-12"],"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":[["","00126007292","PREVDNT","PST 0.011","100","Select","Select",""],["","00591264001","BUT\/APAP\/CAF","CAP ","24","Select","Select",""],["","11527075043","SOD","PST 0.011","100","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","65162035803","ZAFEMY","DIS 150\/35","3","Select","Select",""],["","00378427577","VALACYCLOVIR","TAB 500MG","12","Select","Select",""],["","23155013525","DOXYCYC","TAB 100MG","14","Select","Select",""],["","00378801593","LANSOPRAZOLE","CAP 15MG DR","30","Select","Select",""],["","69238126601","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","51672128902","NYSTATIN","CRE 100000","30","Select","Select",""],["","68462039710","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","00052433001","NEXPLANON","IMP 68MG","1","Select","Select",""],["","67877032005","IBUPROFEN","TAB 600MG","20","Select","Select",""],["","65862078430","ESOMEPRA","CAP 40MG DR","30","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","10","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":""}]}]}