{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  TNERTSENOJ M","gend":0,"add":" HTUOS 0881NL EDISDOOW","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"2001-01-03","age":"","mstatus":"","insh":"5731230*06","cliId":"","pno":"0475755164","cno":"","email":"","ename":"","eno":"","pphy":"SNYDERS, GLENN MD","ppno":7572529600,"pcpadd":"STE 200 1800 CAMELOT DR","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23454-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Pediatric Physicians - Camelot","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.9","R11.2","Z00.00","Z23.","Z71.3","Z71.82","Z13.220","N52.9","F90.0","Q23.1","I49.3","Z68.23"],"date":["2022-05-04","2022-05-04","2022-06-07","2022-06-07","2022-06-07","2022-06-07","2022-07-25","2022-07-25","2022-12-15","2021-07-13","2021-07-13","2021-06-22"],"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":[["","59417010510","VYVANSE","CAP 50MG","30","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","31722063231","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","00172392770","DIAZEPAM","TAB 10MG","1","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","10","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","20","Select","Select",""],["","57237004101","PENICILLN","TAB 500MG","12","Select","Select",""],["","00054418425","DEXAMETHASON","TAB 4MG","2","Select","Select",""],["","13811070810","METHYLPHENID","TAB 36MG ER","30","Select","Select",""],["","70461032003","FLUCLVX","INJ 2020-21","0","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","14","Select","Select",""],["","72647033104","METHYLPRED","TAB 4MG","21","Select","Select",""],["","70748013306","SILDENAFIL","TAB 100MG","3","Select","Select",""],["","50458058801","CONCERTA","27 MG","30","Select","Select",""],["","24208083060","NEO\/POLY\/DEX","SUS 0.1% OP","5","Select","Select",""],["","49884070155","CLOMIPHENE","TAB 50MG","20","Select","Select",""],["","00574403105","TOBRAMYCIN-DEXAMETHASONE","0.3 %-0.1%","5","Select","Select",""],["","13811070810","METHYLPHENID TAB","36MG ER","30","Select","Select",""],["","00591544305","PREDNISONE TAB","20MG","10","Select","Select",""],["","31722072890","MONTELUKAST CHW","5MG","30","Select","Select",""],["","65862085901","FAMOTIDINE TAB","20MG","60","Select","Select",""],["","58160089052","FLUARIX QUAD INJ","2022-23","0","Select","Select",""],["","13811070710","METHYLPHENIDATE ER","27 MG","30","Select","Select",""],["","68462019001","NAPROXEN","500 MG","60","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":""}]}]}