{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"S ELYKRELDA","gend":0,"add":"LUAP 323RD ETTE","city":"NEWPORT NEWS","state":"VA","zip":"23608-9998","dob":"2003-10-15","age":"","mstatus":"","insh":"0103110*53","cliId":"","pno":"05\/7575095-8","cno":"","email":"","ename":"","eno":"","pphy":"BRODERICK, ELIZABETH K MD","ppno":"757\/595-0358","pcpadd":"321 MAIN ST","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23601,"pcpcounty":"","pcpid":"","pcpname":"Childrens Clinic Ltd.","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.11","R11.0","R63.4","U07.1","F41.1","Z23.","J45.21","J20.9","Z00.121","F84.5","Q67.7","F31.9","F43.10","L30.9","B00.9","L21.9","D22.9","Z71.9","R55.","R42.","E86.0","R10.13","R11.11","S06.0X0A","R51.","R68.84","H53.9","F90.9","F41.8","Z79.899","R11.2","J02.9","T50.904A","V62.84","R11.10","F91.3","F90.2","G25.0","L60.0","M25.512","R68.89","T54.92XA","R45.89","J45.909","V58.89","T54.94XA","K20.9","F07.81","K21.9","R07.89","S06.0X9A","R10.9","J06.9","K29.50","F41.9","J30.2","Z91.040","Z88.2","Z91.048","G44.319","R27.9","R25.1","F81.9","Q75.3"],"date":["2020-03-13","2020-03-13","2020-03-13","2021-04-17","2022-11-02","2020-08-28","2020-12-18","2020-12-18","2020-05-28","2021-01-26","2020-05-28","2021-01-26","2021-01-26","2021-04-29","2021-04-29","2021-04-29","2021-04-29","2021-04-29","2020-07-08","2020-07-08","2020-07-08","2019-09-09","2019-09-09","2019-04-09","2019-04-12","2019-04-09","2019-04-09","2019-04-09","2019-04-09","2019-04-12","2019-04-12","2019-03-05","2019-02-21","2019-02-21","2019-02-21","2019-12-04","2019-12-04","2019-09-09","2021-06-29","2019-02-07","2019-02-07","2019-02-22","2019-02-22","2019-02-22","2019-04-09","2019-02-21","2019-02-21","2019-04-12","2019-07-03","2019-02-08","2019-03-19","2019-02-21","2019-02-27","2019-09-09","2019-09-09","2019-09-09","2019-09-09","2019-09-09","2019-09-09","2019-04-12","2019-10-15","2019-10-15","2019-10-15","2019-10-15"],"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":{"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":[["","65862022960","LAMOTRIGINE","TAB 150MG","60","Select","Select",""],["","14539067501","HYDROXYZ","CAP 50MG","90","Select","Select",""],["","50111043401","TRAZODONE","TAB 100MG","60","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","53100020215","FLONASE","SUS 27.5MCG","6","Select","Select",""],["","45802000403","HYDROCORT","CRE 0.025","28","Select","Select",""],["","68462060994","PIMECROLIMUS","CRE 0.01","100","Select","Select",""],["","45802046564","KETOCONAZOLE","SHA 0.02","360","Select","Select",""],["","31722070530","VALACYCLOVIR","TAB 1GM","8","Select","Select",""],["","00187510203","ELIDEL","CRE 0.01","100","Select","Select",""],["","59779030603","CVS","POW ","510","Select","Select",""],["","59417010110","VYVANSE","CAP 10MG","30","Select","Select",""],["","","CYPROHEPTAD","TAB 4MG","","Select","Select",""],["","65162071310","GUANFACINE","TAB 2MG","60","Select","Select",""],["","","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","","TRIAMCINOLON","OIN 0.001","","Select","Select",""],["","","PREDNISONE","TAB 10MG","","Select","Select",""],["","","EPINEPHRINE","INJ 0.3MG","","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","68180016106","AZITHROMYCIN","TAB 500MG","3","Select","Select",""],["","65862019405","FLUOXETINE","CAP 40MG","30","Select","Select",""],["","63402030430","LATUDA","TAB 40MG","60","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","20","Select","Select",""],["","70710101002","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","51991081901","PROPRANOLOL","CAP 120MG ER","30","Select","Select",""],["","10370010150","BUPROPN","TAB 150MG XL","30","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","64380080307","RANITIDINE","TAB 150MG","180","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":""}]}]}