{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EHTNA'EDYRAEW SU","gend":0,"add":"ROKCIH 20402RD HCNARB Y","city":"PETERSBURG                    ","state":"VA","zip":"23803-1778","dob":"2003-03-11","age":"","mstatus":"","insh":"8396587","cliId":"","pno":"2540822396","cno":"","email":"","ename":"","eno":"","pphy":"ARRIETA, MARY C","ppno":8045208135,"pcpadd":"400 Southpark Blvd,Ste D","pcpcity":"Colonial Heights              ","pcpstate":"VA","pcpzip":238342974,"pcpcounty":"","pcpid":"","pcpname":"SOUTHSIDE PEDIATRIC CENTER","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"20402 HICKORY BRANCH DR","add3":"","madd1":"20402 HICKORY BRANCH DR","madd2":"","madd3":"","mcity":"PETERSBURG                    ","mstate":"VA","mzip":"23803-1778","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J10.1","R05","R51","R50.9","L52","D64.9","K51.90","R19.7","R22.43","K51.011","E43","E55.9","T88.7XXA","H11.33","H43.391","H43.392","D62","Z11.59","Z82.49","K51.00","K92.1","Z79.899","E41","Z23","L03.011","M79.644","K52.9","F33.1","J06.9","Z72.0","Z20.828","J02.9","J01.90","R53.83","F32.1","Z00.129","Z01.00","Z01.10","R10.84","R11.2","R10.9","E86.0","N28.9","Z82.79","R63.4","R63.0","Z79.2","K63.89","K20.9","K29.70","Z28.3","Z79.52","R63.3","Z68.52","Z71.3","K51.911","D63.8","G43.909","K62.5","D84.9"],"date":["2020-02-19","2020-02-19","2020-02-19","2020-02-19","2020-06-05","2020-06-15","2021-01-29","2020-06-05","2020-05-03","2020-06-01","2020-07-29","2020-12-16","2020-05-06","2020-05-06","2020-05-13","2020-05-13","2020-06-01","2020-06-01","2020-06-01","2020-07-29","2020-06-05","2020-12-16","2021-01-29","2020-11-05","2020-11-12","2020-11-12","2021-01-29","2021-09-01","2021-10-17","2021-10-17","2021-10-17","2021-10-17","2021-10-25","2021-10-25","2022-03-10","2019-05-28","2019-05-28","2019-05-28","2019-07-16","2019-06-26","2019-08-16","2019-08-15","2019-06-27","2019-08-13","2019-07-30","2019-07-05","2019-07-05","2019-07-16","2019-07-16","2019-07-16","2019-07-22","2019-07-22","2019-07-22","2019-08-27","2019-07-22","2019-08-13","2019-08-13","2019-08-13","2019-08-27","2019-08-27"],"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":[["","57237002901","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","65162046450","IBUPROFEN","TAB 400MG","15","Select","Select",""],["","00603533832","PREDNISONE","TAB 10MG","46","Select","Select",""],["","00185067601","HYDROXYZ","CAP 50MG","60.00","Select","Select",""],["","62135098505","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","65162003310","APAP\/CODEINE","TAB 300-30MG","12","Select","Select",""],["","42571016242","AMOX\/K","TAB 875-125","20","Select","Select",""],["","00536354701","DAILY-VITE","TAB ","30","Select","Select",""],["","75834002001","VITAMIN","CAP 50000UNT","3","Select","Select",""],["","00054458111","MERCAPTOPUR","TAB 50MG","45","Select","Select",""],["","65862056099","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","16714081901","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","00074055402","HUMIRA","INJ 40\/0.4ML","2","Select","Select",""],["","67877021901","CEPHALEXIN","CAP 500MG","15","Select","Select",""],["","68382071119","MESALAMINE","TAB 1.2GM","60","Select","Select",""],["","55111015330","ONDANSETRON","TAB 4MG","12","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","00904053060","TAB-A-VITE","TAB ","30","Select","Select",""],["","00591079501","DICYCLOMINE","TAB 20MG","30","Select","Select",""],["","11822353540","RA","POW ","510","Select","Select",""],["","29300022701","METRONIDAZOL","TAB 500MG","21","Select","Select",""],["","55111015901","OMEPRAZOLE","CAP 40MG","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":""}]}]}