{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RAYNIZAH   T BROWN","gend":1,"add":"3507 SCOTT ST","city":"PORTSMOUTH","state":"VA","zip":"23707-9998","dob":"2002-05-18","age":"","mstatus":"","insh":"7961030*01","cliId":"","pno":"757\/949-1403","cno":"","email":"","ename":"","eno":"","pphy":"BERTOLINO, SIOBHAN M MD","ppno":"757\/461-3890","pcpadd":"SUITE 208 844 KEMPSVILLE RD","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23502,"pcpcounty":"","pcpid":"","pcpname":"MAWC - Tidewater Physicians for Women","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/461-0836","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R05.","G40.909","V49.50XA","R06.02","J35.2","G47.33","D86.9","R06.00","A74.9","N89.8","R56.9","R06.83","D86.89","R51.","S13.4XXA","G40.89","R35.0","N76.0","Z79.51","G40.919","S09.93XA","W22.8XXA","Z30.013","W17.89XA","R10.11","J45.909","L73.2","L02.411","Z86.79","R89.9","D64.9","Z11.3","Z30.42","N92.5","Z32.02"],"date":["2020-03-09","2021-02-26","2020-01-21","2020-01-27","2020-01-27","2020-05-12","2020-05-12","2020-05-12","2021-05-25","2021-10-11","2021-02-26","2020-03-09","2020-03-09","2020-03-10","2020-03-10","2020-03-10","2021-02-17","2021-02-17","2020-03-09","2021-02-26","2019-03-14","2019-03-14","2019-04-17","2019-06-03","2019-09-07","2019-08-25","2019-10-21","2019-08-25","2019-08-25","2019-09-24","2019-09-24","2019-11-21","2019-11-27","2019-11-21","2019-11-27"],"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":[["","51672130406","TERCONAZOLE","CRE 0.004","45","Select","Select",""],["","68180016106","AZITHROMYCIN","TAB 500MG","2","Select","Select",""],["","68180065208","DOXYCYC","CAP 100MG","14","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","68682045570","METRONIDAZOL","GEL 0.75%VAG","70","Select","Select",""],["","","FLOVENT","AER 110MCG","","Select","Select",""],["","","SYMBICORT","AER 80-4.5","","Select","Select",""],["","","PROAIR","AER ","","Select","Select",""],["","","BUDES\/FORMOT","AER 80-4.5","","Select","Select",""],["","","APAP\/CODEINE","TAB 300-30MG","","Select","Select",""],["","","D3","TAB 1000UNIT","","Select","Select",""],["","00093117410","PENICILLN","TAB 500MG","28","Select","Select",""],["","43386035101","HYDROCO\/APAP","TAB 5-300MG","18","Select","Select",""],["","65862024608","LEVETIRACETA","TAB 500MG","30","Select","Select",""],["","59762453802","MEDROXYPR","INJ 150MG\/ML","1","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","40","Select","Select",""],["","00245010801","FERROUS","TAB 325MG EC","30","Select","Select",""],["","00904582460","VITAMIN","TAB 1000UNIT","30","Select","Select",""],["","00781185220","AMOX\/K","TAB 875-125","20","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":""}]}]}