{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" AYAINRELLUF","gend":1,"add":"RG NAYNAB 4683101 TPA NL EVO","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"2003-05-22","age":"","mstatus":"","insh":"1220110*71","cliId":"","pno":"18\/7573008-9","cno":"","email":"","ename":"","eno":"","pphy":"WRIGHT, KELLY L MD","ppno":"757\/436-1770","pcpadd":"612 KINGSBOROUGH SQ STE 301","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":"","pcpname":"CMG - Children's Hospital of The King's Daughters - Pediatric Specialists - Great Bridge Office","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":["Z71.3","F43.12","F32.1","F41.1","F50.81","J98.01","R10.9","K21.9","R19.7","F32.2","J02.9","F60.3","F40.11","Z03.89","F33.9","J45.20","R10.32","Z00.129","H61.21","Z68.53","Z13.31","Z23.","Z71.82","U07.1","R06.02","J45.909","V62.84","Z30.41","F33.1","F40.10","J01.90","B96.89","Z76.0","J02.0","T50.902A"],"date":["2021-07-07","2021-08-11","2021-08-09","2021-08-09","2021-08-11","2019-02-12","2019-02-12","2020-01-08","2019-04-25","2021-12-13","2019-11-18","2021-12-13","2021-12-13","2021-12-13","2020-01-08","2020-01-08","2019-02-25","2019-08-28","2019-08-28","2019-08-28","2019-08-28","2019-08-28","2019-08-28","2021-10-18","2021-10-18","2021-10-18","2020-01-07","2020-01-28","2021-08-11","2021-08-11","2020-03-09","2019-01-24","2019-01-10","2020-11-18","2020-01-06"],"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":[["","","PROAIR"," PROAIR ","8","Select","Select",""],["","","AZITHROMYCIN"," AZITHROMYCIN ","6","Select","Select",""],["","","RANITIDINE"," RANITIDINE ","60","Select","Select",""],["","","AMOXICILLIN"," AMOXICILLIN ","20","Select","Select",""],["","","OPTICHAMBER"," OPTICHAMBER ","1","Select","Select",""],["","","PREDNISONE"," PREDNISONE ","15","Select","Select",""],["","","NIZATIDINE"," NIZATIDINE ","60","Select","Select",""],["","","ALBUTEROL"," ALBUTEROL ","8","Select","Select",""],["","","DOXYCYCL","CAP 100MG","","Select","Select",""],["","","LO","TAB 40452","","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":""}]}]}