{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" YNITSEDDROFSROH","gend":1,"add":"TEW 1058RD YLREH","city":"HENRICO","state":"VA","zip":"23229-9998","dob":"2005-06-20","age":"","mstatus":"","insh":"1936110*59","cliId":"","pno":"83\/4081509-1","cno":"","email":"","ename":"","eno":"","pphy":"PORT, CAROLYN MD","ppno":"804\/266-9616","pcpadd":"STE 110 10571 TELEGRAPH RD","pcpcity":"GLEN ALLEN","pcpstate":"VA","pcpzip":23059,"pcpcounty":"","pcpid":"","pcpname":"Pediatric Center","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","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":["H69.80","J30.9","F41.1","D64.9","U07.1","J06.9","D68.0","Z82.49","R05.","D50.9","E55.9","I49.8","H69.82","H90.0","H65.23","H92.03","R11.2","F19.90","E86.0","R10.32","Z20.822","R11.10","F14.10","T43.625A","J66.2","K59.09","R10.9","G89.29","R10.84","R11.0","Z79.899","R63.4","K52.9","R11.14","N92.5","I95.1","R55.","G90.1","NO DATA","G90.9"],"date":["2021-09-16","2021-03-09","2021-07-21","2021-04-16","2021-09-21","2021-09-21","2022-06-06","2021-09-21","2021-09-21","2022-10-26","2022-10-04","2022-07-01","2020-12-18","2021-02-04","2021-02-10","2022-01-31","2022-03-12","2022-03-12","2022-03-12","2022-03-12","2022-03-12","2022-03-18","2022-03-18","2022-03-18","2022-03-18","2022-09-16","2022-10-04","2022-09-16","2021-03-06","2021-03-06","2022-04-01","2021-02-19","2021-08-25","2022-07-01","2021-06-25","2022-07-01","2022-07-01","2022-10-26","2022-10-18","2022-10-26"],"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":[["","60258018501","POLY-IRON","CAP 150MG","30","Select","Select",""],["","00555901658","SPRINTEC","TAB 28 DAY","28","Select","Select",""],["","00536105227","PEG3350","POW ","510","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","5","Select","Select",""],["","75834002001","VITAMIN","CAP 50000UNT","8","Select","Select",""],["","00555099702","FLUDROCORT","TAB 0.1MG","90","Select","Select",""],["","42291055384","NORGEST\/ETHI","TAB 0.25\/35","28","Select","Select",""],["","64380076921","PEG-3350\/KCL","SOL \/SODIUM","4000","Select","Select",""],["","00904678744","MAG","SOL LEMON","300","Select","Select",""],["","65862017760","CEFDINIR","CAP 300MG","20","Select","Select",""],["","00591544305","PREDNISONE","TAB 20MG","8","Select","Select",""],["","69918030130","TRANEX","TAB 650MG","30","Select","Select",""],["","60505036302","OFLOXACIN","DRO 0.3%OTIC","10","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","60505083305","AZELASTINE","SPR 0.001","30","Select","Select",""],["","65162077810","BUDESONIDE","CAP 3MG DR","90","Select","Select",""],["","64679096101","AZITHROMYCIN","TAB 250MG","4","Select","Select",""],["","00245010811","FERROUS","TAB 325MG EC","60","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":""}]}]}