{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MIA OLSON","gend":1,"add":"4257 INCA DR RANDY AND JO OLSON","city":"RICHMOND","state":"VA","zip":"23237-9998","dob":"2000-07-18","age":"","mstatus":"","insh":"2095042*01","cliId":"","pno":8044890967,"cno":8044890967,"email":"","ename":"","eno":"","pphy":"OLSEN, NINA S MD","ppno":8048972100,"pcpadd":"10710 MIDLOTHIAN TURNPIKE","pcpcity":"RICHMOND","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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.1","F25.0","F90.0","F90.2","R10.2","B37.3","N94.2","N94.819","F33.2","F90.1"],"date":["2023-03-02","2023-02-27","2023-02-27","2022-04-19","2022-12-02","2022-05-12","2022-05-12","2022-05-12","2021-11-15","2021-11-15"],"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":[["","27241005603","ARIPIPRAZOLE","TAB 30MG","30","Select","Select",""],["","33342006707","OLANZAPINE","TAB 2.5MG","30","Select","Select",""],["","00093506201","HYDROXYZ HCL","TAB 50MG","120","Select","Select",""],["","54092038701","ADDERALL XR","20 MG","30","Select","Select",""],["","00527551337","AMPHET\/DEXTR","CAP 20MG ER","30","Select","Select",""],["","60505265301","TRAZODONE","TAB 50MG","180","Select","Select",""],["","00378110101","PRAZOSIN HCL","CAP 1MG","60","Select","Select",""],["","00115165901","PROPRANOLOL","TAB 10MG","90","Select","Select",""],["","68462011944","FLUCONAZOLE","TAB 150MG","3","Select","Select",""],["","13107003105","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","00472037915","CLOTRIM\/BETA","CRE DIPROP","30","Select","Select",""],["","00781235201","DEXTROAMPHETAMINE-AMPHET ER","20 MG","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":""}]}]}