{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRITTANY BAKER-STIGALL","gend":1,"add":"6121 NEWBYS BRIDGE ROAD","city":"CHESTERFIELD","state":"VA","zip":"23832-9998","dob":"1990-04-12","age":"","mstatus":"","insh":"1715624*01","cliId":"","pno":8047120897,"cno":8047120897,"email":"","ename":"","eno":"","pphy":"SANTOSH, PADMINI MD","ppno":8078972100,"pcpadd":"1212 KOGER CENTER BLVD,","pcpcity":"NORTH CHESTERFIELD","pcpstate":"VA","pcpzip":"23235-9998","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":8048979074,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H66.92","N30.00","L30.9","F11.20","Z01.419","Z32.02","F41.9","NO DATA","I10.","F11.93","F11.10","F11.23","F12.90","E66.3","Z30.09","Z68.27","F33.1","F41.1","F33.2","Z20.822","N76.0","B96.89","Z30.433","F32.0","F33.9","F31.81","F31.9","Z20.828"],"date":["2021-05-07","2021-05-07","2021-05-07","2023-05-02","2022-12-20","2023-02-20","2022-12-20","2022-12-20","2022-12-20","2022-10-10","2022-10-10","2023-06-18","2022-10-10","2023-02-20","2022-12-20","2023-02-20","2022-04-21","2022-04-19","2022-04-20","2021-10-19","2023-02-20","2023-02-20","2023-01-16","2022-07-26","2022-08-01","2022-08-01","2021-03-08","2021-02-17"],"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":[["","00054018913","BUPREN\/NALOX","SUB 8-2MG","20","Select","Select",""],["","12496120803","SUBOXONE","MIS 8-2MG","6","Select","Select",""],["","70436001102","BUPROPN HCL","TAB 300MG XL","90","Select","Select",""],["","71093011205","GABAPENTIN","800 MG","90","Select","Select",""],["","00228212810","CLONIDINE","TAB 0.2MG","90","Select","Select",""],["","68180051801","LISINOP\/HCTZ","TAB 10-12.5","30","Select","Select",""],["","69584009350","BUSPIRONE","TAB 15MG","90","Select","Select",""],["","13668013501","ESCITALOPRAM","TAB 5MG","30","Select","Select",""],["","59651032430","FLUOXETINE","TAB 60MG","30","Select","Select",""],["","50111045001","TRAZODONE","TAB 150MG","30","Select","Select",""],["","31722070430","VALACYCLOVIR","TAB 500MG","10","Select","Select",""],["","69584009350","BUSPIRONE HCL","15 MG","90","Select","Select",""],["","68180051801","LISINOPRIL-HYDROCHLOROTHIAZIDE","10-12.5MG","30","Select","Select",""],["","50111033401","METRONIDAZOLE","500 MG","14","Select","Select",""],["","00228212810","CLONIDINE HCL","0.2 MG","90","Select","Select",""],["","68180032006","BUPROPION XL","300 MG","90","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":""}]}]}