{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   SUXXELNAMWOB B","gend":1,"add":" TSEW 4043 TPA TC","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"2004-04-27","age":"","mstatus":"","insh":"0412210*00","cliId":"","pno":"17\/7571885-4","cno":"","email":"","ename":"","eno":"","pphy":"GREGORY, AMY J NP","ppno":"757\/333-7797","pcpadd":"SUITE 118 324 LOUISA AVENUE","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":"","pcpname":"CMG - Children's Hospital of The King's Daughters - Partners in Pediatric Care","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":["F32.9","F33.9","J45.20","F19.951","V62.84","F43.21","F16.983","F22.","R44.0","R45.1","R10.2","Z20.822","R52.","Z79.3","N89.8","R10.84","Z13.31","R11.0","R11.11","K59.1","N92.1","J06.9","Z20.828","Z30.9","N94.6","R10.30","F41.9","N39.0","R31.9","N76.0","B96.89","N83.201","A74.9","N34.2","N73.9","N83.12","F43.25","Z11.3","N93.9","R10.32","N83.292","Z30.41","F12.90","R63.4","Z91.14","Z01.812","Z68.51","F33.1","F41.1","F50.9","F12.20","F31.81","N92.0","F43.10","F17.200","J10.1","R63.0","R68.81","E43.","F50.01","G89.29","F60.3","Z91.19","Z72.0","Z81.8","I45.81","R62.51","Z00.121","M54.9","Z23.","Z71.3","Z28.82","R63.6","R19.7"],"date":["2021-09-14","2021-09-15","2021-09-15","2021-09-17","2021-09-17","2021-09-17","2021-12-17","2021-02-13","2021-02-13","2021-02-13","2021-09-28","2022-08-28","2021-09-04","2021-09-04","2021-11-09","2022-03-14","2022-03-29","2022-02-16","2021-11-29","2022-02-16","2021-12-21","2020-08-09","2020-08-09","2022-03-29","2021-06-29","2021-09-04","2022-03-31","2020-12-07","2020-12-07","2020-12-07","2020-12-07","2020-12-07","2020-12-09","2020-12-09","2020-12-09","2021-06-15","2021-03-02","2022-10-21","2020-12-07","2021-06-07","2021-06-07","2021-06-07","2022-02-16","2022-03-14","2022-02-16","2022-02-16","2022-03-29","2022-05-03","2022-05-03","2022-04-19","2022-03-10","2022-04-19","2022-03-29","2022-03-31","2022-03-31","2022-08-28","2022-03-14","2022-03-14","2022-02-07","2022-02-07","2022-02-07","2022-02-07","2022-02-07","2022-02-07","2022-02-07","2022-02-08","2022-02-08","2022-03-29","2022-03-29","2022-03-29","2022-03-29","2022-03-29","2022-03-29","2022-02-16"],"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":[["","00115175701","CYPROHEPTAD","TAB 4MG","30","Select","Select",""],["","67877043103","ARIPIPRAZOLE","TAB 5MG","30","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","68382050010","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","00591079501","DICYCLOMINE","TAB 20MG","30","Select","Select",""],["","11917017229","NICOTINE","DIS 14MG\/24H","28","Select","Select",""],["","51862086806","MICROGESTIN","TAB 43831","84","Select","Select",""],["","00378464226","ESTRADIOL","DIS 0.05MG","8","Select","Select",""],["","00004080085","TAMIFLU","CAP 75MG","10","Select","Select",""],["","69238126601","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","68462013281","NORETH\/ETHIN","TAB 43831","21","Select","Select",""],["","66993037083","MEDROXYPR","INJ 150MG\/ML","1","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","50111064801","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","67877024201","QUETIAPINE","TAB 25MG","30","Select","Select",""],["","65862001105","SERTRALINE","TAB 25MG","30","Select","Select",""],["","65862037401","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","68462018135","CLOTRIMAZOLE","CRE 0.01","30","Select","Select",""],["","00143980305","DOXYCYCL","CAP 100MG","28","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","6","Select","Select",""],["","00406048410","APAP\/CODEINE","TAB 300-30MG","12","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":""}]}]}