{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   NEEH'IKLLESSUR J","gend":0,"add":"ELLAB 9262DVLB ENITN","city":"NORFOLK","state":"VA","zip":"23509-9998","dob":"2002-10-24","age":"","mstatus":"","insh":"0626810*03","cliId":"","pno":"58\/7570198-8","cno":"757\/962-4918","email":"","ename":"","eno":"","pphy":"CUMMINGS, ROSE M DO","ppno":"757\/668-7213","pcpadd":"601 CHILDRENS LANE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23507,"pcpcounty":"","pcpid":"","pcpname":"CSG - Children's Hospital of The King's Daughters - Pediatric Cardiology","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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.9","L70.8","R03.0","Z71.3","E66.01","F32.9","F90.2","F10.20","F41.1","F32.2","V62.84","F91.3","E66.9","Z68.54","R73.03","I10.","Z20.828","F12.10","L70.9","F90.9","G47.00","R63.5","L83.","N62.","T25.212A","L70.0"],"date":["2020-09-01","2020-09-01","2020-09-16","2020-09-16","2020-09-16","2021-07-20","2021-07-20","2020-08-04","2021-07-20","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2021-09-08","2020-09-02","2020-12-21","2019-02-22","2019-02-22","2019-07-31","2019-06-19","2019-06-19","2019-09-17","2019-04-30"],"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":[["","68645052354","SERTRALINE","TAB 100MG","30","Select","Select",""],["","","BUPROPN","TAB 150MG XL","","Select","Select",""],["","","RETIN-A","CRE 0.00025","","Select","Select",""],["","","TOPIRAMATE","TAB 50MG","","Select","Select",""],["","","PHENTERMINE","TAB 37.5MG","","Select","Select",""],["","","LISINOPRIL","TAB 10MG","","Select","Select",""],["","","DOXYCYC","TAB 100MG","","Select","Select",""],["","","TRIAMT\/HCTZ","TAB 37.5-25","","Select","Select",""],["","59417010410","VYVANSE","CAP 40MG","30","Select","Select",""],["","29300013501","CLONIDINE","TAB 0.1MG","30","Select","Select",""],["","00472011745","TRETINOIN","CRE 0.00025","45","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":""}]}]}