{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  ADNYLXOF A ","gend":1,"add":"FXEW 841E RD DRO","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1969-11-09","age":"","mstatus":"","insh":"47200210*68","cliId":"","pno":"42\/7574058-2","cno":"757\/332-0285","email":"","ename":"","eno":"","pphy":"NGWA, BENEDICT NP","ppno":"757\/483-1700","pcpadd":"4868 BRIDGE RD STE 300","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23435,"pcpcounty":"","pcpid":"","pcpname":"Lakeview Pediatrics & Family Medicine","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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F10.239","E87.2","E87.1","N39.0","R56.9","E87.6","J44.9","I25.2","G40.909","I10.","F17.210","E78.5","Z88.0","Z87.820","Z79.899","G40.919","R00.0","S27.2XXA","F10.10","F10.230","R41.82","R40.4","T07.XXXA","F10.231","F10.20","Z09.","S22.31XA","G40.89","F41.9","I25.10","T79.7XXA","Z20.828","Z90.710","Z82.3","Z83.3","Z28.21","J96.01","I50.21","G93.40","E44.0","E86.0","Z80.9","Z82.49","D72.829","B19.20","J43.9","S27.0XXA","S22.41XA","W19.XXXA","R12.","R94.5","K76.0","Z12.11","F17.200","I34.0","I70.0","R06.02","R09.02","G93.41","J44.1","Z79.51","I50.23","R74.8","Z23.","J18.9","A41.9","J44.0","Z95.5","R07.89","Z87.891","L08.9","Z00.00","G89.29","M65.312","Z12.31","M79.645"],"date":["2021-11-07","2021-11-11","2020-07-10","2020-07-10","2021-11-15","2020-10-05","2022-03-04","2020-10-15","2020-10-05","2022-08-08","2021-11-05","2022-08-08","2021-11-05","2020-10-15","2020-10-15","2020-10-05","2021-11-05","2020-10-18","2022-07-08","2021-11-11","2021-11-15","2021-11-05","2020-10-15","2021-11-15","2021-11-15","2021-11-23","2020-10-18","2021-11-05","2020-10-15","2022-03-04","2020-10-15","2020-10-15","2020-10-15","2021-11-05","2021-11-05","2020-10-15","2021-11-05","2021-11-05","2021-11-05","2021-11-05","2021-11-05","2021-11-05","2021-11-05","2021-11-05","2021-11-05","2021-11-10","2020-10-17","2020-10-17","2020-10-18","2020-11-20","2020-11-20","2020-11-20","2020-11-20","2020-11-20","2021-11-08","2021-11-08","2020-10-15","2020-10-15","2021-11-07","2020-10-05","2020-10-05","2022-07-08","2022-03-04","2021-11-23","2019-08-10","2019-08-07","2019-08-07","2019-08-07","2019-08-06","2019-08-06","2019-09-04","2022-07-08","2022-08-08","2022-08-08","2022-07-08","2022-07-08"],"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":[["","","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","76385011050","CARVEDILOL","TAB 3.125MG","60","Select","Select",""],["","59779060462","IBUPROFEN","TAB 200MG","30","Select","Select",""],["","68180051201","LISINOPRIL","TAB 2.5MG","30","Select","Select",""],["","","ATORVASTATIN","TAB 20MG","","Select","Select",""],["","","FOLIC","TAB 1000MCG","","Select","Select",""],["","10006070011","VITAMIN","TAB 100MG","30","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","30","Select","Select",""],["","","ASPIRIN","CHW 81MG","","Select","Select",""],["","59779061270","ALLERGY","TAB 10MG","30","Select","Select",""],["","57896055510","SENNA-PLUS","TAB 8.6-50MG","30","Select","Select",""],["","00536589688","NICOTINE","DIS 21MG\/24H","28","Select","Select",""],["","68462043518","ACAMPRO","TAB 333MG","180","Select","Select",""],["","57896062101","THERA-TABS","TAB ","30","Select","Select",""],["","65162044110","MECLIZINE","TAB 12.5MG","20","Select","Select",""],["","40985022368","THERAPEUTIC-","TAB M\/LUTEIN","30","Select","Select",""],["","50428048545","CVS","TAB 100MG","30","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","68180045901","AMLOD\/BENAZP","CAP 5-20MG","30","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","00093720198","PRAVASTATIN","TAB 20MG","90","Select","Select",""],["","","OXYCODONE","TAB 5MG","","Select","Select",""],["","","DOCUSATE","CAP 100MG","","Select","Select",""],["","","MAG","TAB 400MG","","Select","Select",""],["","","POT  CHLORIDE","TAB 20MEQ ER","","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","","CEFPROZIL","TAB 250MG","","Select","Select",""],["","","BUDES\/FORMOT","AER 160-4.5","","Select","Select",""],["","","NAPROXEN","TAB 500MG","","Select","Select",""],["","00555015802","CHLORDIAZEP","CAP 5MG","8","Select","Select",""],["","","NARCAN","SPR ","","Select","Select",""],["","","METHOCARBAM","TAB 500MG","","Select","Select",""],["","","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","23155000101","HYDRALAZINE","TAB 10MG","90","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","10","Select","Select",""],["","68180016106","AZITHROMYCIN","TAB 500MG","2","Select","Select",""],["","00054001729","PREDNISONE","TAB 10MG","24","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":""}]}]}