{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LEVIA JONES","gend":1,"add":"310 NEWBRIDGE RD APT 125","city":"RICHMOND","state":"VA","zip":"23223-9998","dob":"1993-02-12","age":"","mstatus":"","insh":"1982525*01","cliId":"","pno":8049263374,"cno":8049263374,"email":"","ename":"","eno":"","pphy":"MEAD, THOMAS P MD","ppno":8047300800,"pcpadd":"STE A 8239 MEADOWBRIDGE RD,","pcpcity":"MECHANICSVILLE","pcpstate":"VA","pcpzip":"23116-9998","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":8047300839,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.4","F43.10","Z30.42","R11.2","A08.4","R10.84","Z20.822","N93.8","Z30.09","N83.202","F43.20","NO DATA","N94.6","N92.6","Z30.46","Z32.02","Z86.2","Z87.891","Z79.899","R10.2","K29.70","F12.10","F17.200","F90.0","S16.1XXA","V89.2XXA","H66.92","Z72.0","Z20.828","R05.","D25.9"],"date":["2022-04-20","2022-07-12","2023-04-11","2023-03-07","2023-03-07","2023-03-07","2023-03-07","2023-06-06","2023-06-27","2023-06-27","2022-04-05","2022-02-07","2023-03-02","2021-12-28","2021-12-28","2023-04-11","2023-03-07","2023-03-07","2023-03-07","2023-03-02","2023-03-07","2023-03-07","2022-02-07","2022-04-20","2021-06-09","2021-06-09","2021-08-01","2021-08-01","2021-08-01","2021-08-01","2021-12-28"],"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":[["","50111064801","FLUOXETINE CAP","20MG","30","Select","Select",""],["","50111033402","METRONIDAZOL TAB","500MG","14","Select","Select",""],["","57237000511","FLUCONAZOLE TAB","150MG","1","Select","Select",""],["","63402030230","LATUDA TAB","20MG","30","Select","Select",""],["","50458058501","CONCERTA TAB","18MG","30","Select","Select",""],["","31722095301","METHYLPHENID TAB","27MG ER","30","Select","Select",""],["","68180086573","BLISOVI FE TAB","1\/20","28","Select","Select",""],["","66993037179","MEDROXYPROGESTERONE ACETATE","150 MG\/ML","1","Select","Select",""],["","00603116158","DICYCLOMINE HCL","10 MG\/5 ML","200","Select","Select",""],["","00172572860","FAMOTIDINE","20 MG","20","Select","Select",""],["","65862018730","ONDANSETRON HCL","4 MG","20","Select","Select",""],["","63402030230","LATUDA","TAB 20MG","30","Select","Select",""],["","50111064801","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","68180086573","BLISOVI FE","TAB 44946","28","Select","Select",""],["","31722095301","METHYLPHENID","TAB 27MG ER","30","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","50458058501","CONCERTA","TAB 18MG","30","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":""}]}]}