{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MYLIAH   H SCOTT","gend":1,"add":"161 BAY POINTE DR","city":"MONTROSS","state":"VA","zip":"22520-9998","dob":"2004-07-05","age":"","mstatus":"","insh":"9480145*01","cliId":"","pno":"804\/456-8316","cno":"","email":"","ename":"","eno":"","pphy":"MEAD, THOMAS P MD","ppno":"804\/730-0800","pcpadd":"STE A 8239 MEADOWBRIDGE RD","pcpcity":"MECHANICSVILLE","pcpstate":"VA","pcpzip":23116,"pcpcounty":"","pcpid":"","pcpname":"Dominion Women's Health","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/730-0839","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B35.4","Z32.01","F43.8","R05.9","R09.81","Z20.822","Z20.828","J01.90","Q21.0","Z77.22","O41.03X0","E66.9","J45.909","Z37.0","O99.52","Z3A.38","O99.214","O70.0","O80.","Z3A.00","Z64.0","J34.89","Z30.09","R07.9","J18.9","I49.5","U07.1","R11.2","R07.89","R06.02"],"date":["2020-10-15","2020-11-16","2021-03-15","2021-10-03","2021-10-03","2021-10-03","2020-12-11","2021-08-08","2021-10-03","2021-10-03","2021-07-01","2021-07-01","2021-07-01","2021-07-02","2021-07-01","2021-07-02","2021-07-01","2021-07-01","2021-07-02","2021-07-02","2021-03-04","2021-08-08","2021-09-14","2022-04-11","2022-04-11","2022-04-11","2022-06-13","2022-06-13","2022-10-26","2022-10-26"],"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":[["","65862077685","MILI","TAB 0.25\/35","28","Select","Select",""],["","59762219807","AZITHROMYCIN","TAB 250MG","4","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","00555901658","SPRINTEC","TAB 28 DAY","28","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","60","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","10","Select","Select",""],["","11917009215","FERROUS","TAB 325MG","60","Select","Select",""],["","59651036205","IBUPROFEN","TAB 800MG","20","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","6","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","14","Select","Select",""],["","","CLOTRIM\/BETA","CRE DIPROP","","Select","Select",""],["","","OB","CAP PETITE","","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":""}]}]}