{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  ASEELAJNOTTUS D ","gend":1,"add":"TTOCS 969A TPA TS ","city":"NORFOLK","state":"VA","zip":"23502-9998","dob":"1992-06-09","age":"","mstatus":"","insh":"2553210*12","cliId":"","pno":"85\/7578051-1","cno":"","email":"","ename":"","eno":"","pphy":"ESCALERA II, ROBERT MD","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":["M25.561","M25.562","I10.","O20.8","Z3A.01","O46.91","O23.591","B96.89","E87.6","Z3A.13","O36.5930","Z37.0","Z3A.38","Z23.","Z34.83","O36.5990","O14.13","Z3A.34","O14.14","O60.14X0","O62.3","Z82.49","Z83.3","Z82.5","Z81.8","Z20.828","O21.9","F33.2","O20.0","Z67.10","R10.2","N92.6"],"date":["2020-10-19","2020-10-19","2020-10-19","2021-11-04","2021-11-04","2020-05-17","2020-05-17","2020-05-17","2020-05-17","2020-05-17","2020-10-14","2020-10-14","2019-03-09","2019-03-09","2019-03-09","2020-10-08","2020-10-14","2020-10-14","2020-10-14","2020-10-14","2020-10-14","2020-10-14","2020-10-14","2020-10-14","2020-10-14","2020-10-14","2020-09-02","2021-01-22","2021-11-04","2021-11-04","2021-11-04","2020-03-31"],"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":[["","65862039010","ONDANSETRON","TAB 4MG ODT","30","Select","Select",""],["","","PRENATAL"," PRENATAL ","30","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","14","Select","Select",""],["","","VITAMIN","CAP 50000UNT","","Select","Select",""],["","49483048112","ASPIRIN","TAB 81MG EC","60","Select","Select",""],["","68180016006","AZITHROMYCIN","TAB 250MG","8","Select","Select",""],["","50428016183","CVS","CAP 2000UNIT","60","Select","Select",""],["","","IRON","TAB 325MG","","Select","Select",""],["","","METOCLOPRAM","TAB 10MG","","Select","Select",""],["","","METRONIDAZOL","TAB 500MG","","Select","Select",""],["","","CALCIUM\/D3","TAB 600MG","","Select","Select",""],["","","NIFEDIPINE","TAB 30MG ER","","Select","Select",""],["","","ACETAMINOPHE","TAB 325MG","","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":""}]}]}