{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CNESSESPPE E","gend":1,"add":"SSECNIRP E 42731 TPA DR ENNA ","city":"NORFOLK","state":"VA","zip":"23502-9998","dob":"2003-08-26","age":"","mstatus":"","insh":"1209110*37","cliId":"","pno":"23\/7570307-1","cno":"","email":"","ename":"","eno":"","pphy":"CAVES, KYZWANA NIA MD","ppno":"757\/668-7007","pcpadd":"301 RIVERVIEW AVENUE SUITE 3","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23510,"pcpcounty":"","pcpid":"","pcpname":"CSG - Children's Hospital of The King's Daughters - Adolescent Medicine - Health Ctr at Fort Norfolk","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":["L70.0","Z79.899","Z32.01","Z30.09","R51.9","R42.","F32.9","M25.471","M25.472","N39.0","H61.23","Z20.822","Z32.02","K13.0","Z30.42","Z11.3","Z30.013","Z87.59","N92.1","Z31.5","O35.9XX0","Z3A.10","S46.912A","Z79.3","R60.9","Z13.31"],"date":["2022-10-10","2021-05-19","2021-05-24","2021-07-12","2021-07-05","2021-07-05","2021-07-05","2022-09-24","2022-09-24","2022-09-24","2022-10-13","2021-09-04","2021-01-29","2021-05-19","2022-09-12","2020-09-25","2021-07-12","2021-07-12","2021-12-27","2021-06-18","2021-06-18","2021-06-18","2022-06-11","2022-09-24","2022-09-24","2021-02-11"],"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":[["","00187516045","RETIN-A","CRE 0.00025","45","Select","Select",""],["","58160084252","BOOSTRIX","INJ ","0","Select","Select",""],["","43528000305","HEPLISAV-B","INJ 20\/0.5ML","0","Select","Select",""],["","59267102504","PFIZER","INJ ADLT RTU","0","Select","Select",""],["","49281040020","ADACEL","INJ ","0","Select","Select",""],["","00574220145","TRETINOIN","CRE 0.001","45","Select","Select",""],["","16729022601","SPIRONOLACT","TAB 50MG","30","Select","Select",""],["","45802026337","CLINDAMYCIN","MIS 0.01","60","Select","Select",""],["","00548540000","MEDROXYPR","INJ 150MG\/ML","1","Select","Select",""],["","00378661493","AMNESTEEM","CAP 40MG","30","Select","Select",""],["","45802000403","HYDROCORT","CRE 0.025","28","Select","Select",""],["","69238101703","ISOTRETINOIN","CAP 30MG","30","Select","Select",""],["","57237007530","ONDANSETRON","TAB 4MG","10","Select","Select",""],["","10702019201","HYDROCO\/APAP","TAB 5-300MG","16","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","28","Select","Select",""],["","42192032090","PNV-SELECT","TAB ","90","Select","Select",""],["","69238110002","DOXYCYCL","CAP 100MG","12","Select","Select",""],["","00555105686","CLARAVIS","CAP 30MG","30","Select","Select",""],["","00378334053","XULANE","DIS 150-35","3","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":""}]}]}