{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" N   AXELAZEUQZALEV","gend":1,"add":"IUT 948RD NOIT","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"2004-10-22","age":"","mstatus":"","insh":"3879110*50","cliId":"","pno":"29\/7872122-9","cno":"","email":"","ename":"","eno":"","pphy":"DISON, DANIEL I MD","ppno":"757\/668-6700","pcpadd":"2088 PRINCESS ANNE ROAD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23456,"pcpcounty":"","pcpid":"","pcpname":"CMG - Children's Hospital of The King's Daughters - General Booth Pediatrics","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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F84.0","F90.2","F72.","Z03.818","Z11.59","N94.89","Z30.42","V62.89","F45.8","R74.0","K21.9","K59.04","R14.0","F90.9","R62.50","F71.","N94.0","K59.01","L30.9","R63.4","R10.9","N92.0","N92.6"],"date":["2020-03-09","2020-02-05","2020-02-05","2020-07-09","2020-07-09","2020-04-22","2020-04-22","2020-04-22","2020-03-09","2020-03-09","2020-03-09","2019-01-22","2019-08-26","2019-03-06","2019-04-24","2019-04-24","2019-08-07","2019-10-30","2019-05-24","2019-08-26","2019-11-13","2019-05-08","2019-05-08"],"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":[["","","SMOOTH","POW ","","Select","Select",""],["","54838057059","ARIPIPRAZOLE","SOL 1MG\/ML","150","Select","Select",""],["","59651000101","OMEPRAZOLE","CAP 10MG","30","Select","Select",""],["","45802086802","POLYETH","POW 3350 NF","238","Select","Select",""],["","54092039101","ADDERALL","CAP 30MG","30","Select","Select",""],["","66993059902","AMPHET\/DEXTR","CAP 30MG ER","30","Select","Select",""],["","11523723404","MIRALAX","POW 3350 NF","510","Select","Select",""],["","59762453701","MEDROXYPR","INJ 150MG\/ML","1","Select","Select",""],["","57896045208","SENNA","SYP 8.8MG\/5","80","Select","Select",""],["","49100036404","CULTURELLE","CAP HLTH\/WEL","30","Select","Select",""],["","45802001402","HYDROCORT","OIN 0.025","60","Select","Select",""],["","64980040906","SERTRALINE","CON 20MG\/ML","23","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":""}]}]}