{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   ASSERTSKOORB R","gend":1,"add":" EVA TNOMESOR 6101EVA TNOMESOR 6101","city":"CHESAPEAKE","state":"VA","zip":"23324-9998","dob":"1990-02-20","age":"","mstatus":"","insh":"40500210*81","cliId":"","pno":"83\/7027847-5","cno":"","email":"","ename":"","eno":"","pphy":"URBAN, KATHERINE LUNNEY MD","ppno":"757\/461-6342","pcpadd":"SUITE 200 885 KEMPSVILLE ROAD","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23502,"pcpcounty":"","pcpid":"","pcpname":"CMG - Children's Hospital of The King's Daughters - Pediatric Specialists - Grassfield Office","plan":"OHP","program":"MEDICAID","lob":"OHCC","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":["O21.9","O23.41","N76.0","B96.89","O41.8X10","O46.8X1","O23.591","O99.891","R82.71","Z3A.12","F17.210","R50.9","J06.9","O98.912","N12.","Z3A.23","Z72.0","O99.344","O72.1","Z37.0","Z3A.37","Z87.440","F41.9","O99.334","Z80.0","Z80.1","Z80.51","Z80.6","Z82.49","Z82.5","Z83.2","Z83.3","Z20.822","O23.02","Z3A.22","R05.9","R06.02","R51.9","R63.0","F17.200","N30.00","M25.541","O26.891","N93.9","Z20.2","Z72.51","Z34.83","Z3A.36","N89.8","Z36.85","Z32.00","O20.9","Z3A.01","O23.592","Z3A.16","B37.3","O26.92","Z36.1","E87.1","O99.282","E86.0","O99.012","D64.9","O99.342","F31.9","F43.10","F41.8","O99.332","Z79.899","Z88.5","Z91.030","Z3A.28","O26.893","O36.0130","Z39.1","O92.29","Z13.32","M54.5","Z39.2","Z30.09","A60.04","O23.11","Z3A.31","Z23.","Z33.1","O09.42","O26.899","Z67.91","Z3A.17","O20.8","R10.2","Z34.81","Z3A.09","O80."],"date":["2021-09-26","2020-10-19","2021-06-24","2021-09-26","2019-01-15","2019-01-15","2021-09-26","2021-09-26","2021-09-26","2021-09-26","2021-09-26","2020-07-22","2020-07-22","2021-01-13","2021-01-13","2021-01-13","2021-01-13","2021-05-01","2021-05-01","2021-05-02","2021-05-02","2021-12-26","2021-05-01","2021-05-01","2021-05-01","2021-05-01","2021-05-01","2021-05-01","2021-05-01","2021-05-01","2021-05-01","2021-05-01","2021-12-26","2021-01-13","2021-01-13","2021-12-26","2021-12-26","2021-12-26","2021-12-26","2021-12-26","2020-01-08","2019-06-16","2020-01-08","2020-01-08","2021-06-24","2020-07-10","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-09-22","2019-01-15","2020-09-27","2020-12-04","2020-12-04","2021-06-24","2020-12-04","2020-12-04","2021-01-13","2021-01-13","2021-01-13","2021-01-13","2021-01-13","2021-01-13","2021-01-13","2021-01-13","2021-01-13","2021-01-13","2021-01-13","2021-01-13","2021-01-13","2021-03-01","2021-03-01","2021-03-01","2021-03-01","2021-03-01","2021-06-14","2021-03-01","2021-06-14","2021-06-14","2021-06-24","2020-09-27","2021-03-23","2021-11-03","2021-03-23","2021-11-03","2021-11-03","2021-11-03","2021-11-03","2020-09-27","2020-09-27","2020-10-19","2020-10-19","2021-05-02"],"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":[["","","METRONIDAZOL"," METRONIDAZOL ","70","Select","Select",""],["","","VITAMIN"," VITAMIN ","15","Select","Select",""],["","","CEPHALEXIN"," CEPHALEXIN ","40","Select","Select",""],["","","PROMETHEGAN"," PROMETHEGAN ","12","Select","Select",""],["","","ONDANSETRON"," ONDANSETRON ","20","Select","Select",""],["","","PROMETHAZINE"," PROMETHAZINE ","12","Select","Select",""],["","","AZITHROMYCIN"," AZITHROMYCIN ","1","Select","Select",""],["","","UNISOM"," UNISOM ","30","Select","Select",""],["","","HYDROCO\/APAP"," HYDROCO\/APAP ","6","Select","Select",""],["","","AMOX\/K"," AMOX\/K ","20","Select","Select",""],["","","NAPROXEN"," NAPROXEN ","20","Select","Select",""],["","","ESTARYLLA","TAB 0.25-35","","Select","Select",""],["","","PRENATAL","CHW TAB","","Select","Select",""],["","","TERCONAZOLE","CRE 0.008","","Select","Select",""],["","","OXYCOD\/APAP","TAB 7.5-325","","Select","Select",""],["","","SPRINTEC","TAB 28 DAY","","Select","Select",""],["","","BENZONATATE","CAP 200MG","","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":""}]}]}