{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VIRGINIA JONES","gend":1,"add":"16 N FOLEY ST","city":"PETERSBURG","state":"VA","zip":"23803-9998","dob":"1971-08-23","age":"","mstatus":"","insh":"2215155*01","cliId":"","pno":"804\/399-7486","cno":"804\/399-7486","email":"","ename":"","eno":"","pphy":"FOSTER, MELISSA NP","ppno":"804\/897-2100","pcpadd":"2025 WATERSIDE ROAD SUITE 201","pcpcity":"PRINCE GEORGE","pcpstate":"VA","pcpzip":23875,"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":["F31.9","F20.9","R56.9","F25.0","D50.9","R41.82","F19.929","R77.8","G40.309","F33.1","F33.3","R40.20","R40.2431","M79.672","R51.","Z20.828","R05.","R06.02","R50.9","A53.9","F31.0"],"date":["2020-10-20","2021-07-19","2021-11-09","2021-04-28","2021-09-06","2021-09-06","2021-09-06","2021-09-06","2020-09-10","2021-07-27","2021-09-09","2020-06-07","2020-06-07","2020-06-10","2020-06-10","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2021-04-30","2021-05-11"],"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":[["","67877025010","QUETIAPINE","TAB 100MG","180","Select","Select",""],["","68180011507","LEVETIRACETA","TAB 1000MG","180","Select","Select",""],["","50111043401","TRAZODONE","TAB 100MG","30","Select","Select",""],["","65862019405","FLUOXETINE","CAP 40MG","30","Select","Select",""],["","43547030303","ARIPIPRAZOLE","TAB 5MG","30","Select","Select",""],["","69097081312","GABAPENTIN","CAP 100MG","60","Select","Select",""],["","66758017001","KLOR-CON","TAB 10MEQ ER","20","Select","Select",""],["","58160084252","BOOSTRIX","INJ ","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":""}]}]}