{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" NOVIAJNERRAW","gend":0,"add":"NALTROP 8103101 TPA TS D","city":"PORTSMOUTH","state":"VA","zip":"23707-9998","dob":"2004-12-04","age":"","mstatus":"","insh":"4728910*74","cliId":"","pno":"38\/7579134-9","cno":"757\/966-9217","email":"","ename":"","eno":"","pphy":"ONGKINGCO, JOSE RAMON MD","ppno":"757\/668-6500","pcpadd":"BLDG B 171 KEMPSVILLE RD","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23502,"pcpcounty":"","pcpid":"","pcpname":"CMG - Children's Hospital of The King's Daughters - Tidewater Children's Associates","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":["G40.409","D70.9","R05.","R09.81","G44.219","R56.9","B07.0","M21.6X9","Q66.50","M20.40","M79.672","S01.112A","S06.0X0A","J45.909","Z79.899","W18.39XA","W22.8XXA","Y93.01","R51.9","Z20.828","M21.6X2","Q66.52","M20.42","S61.411A","S61.214A","S61.216A","W25.XXXA","Z48.02","V58.89","R25.8","Q66.51","M20.41","M79.671","Z02.5","G44.211","R40.4","G40.319","J30.89","S61.012A","W26.8XXA","J06.9","J30.9","R51."],"date":["2020-01-27","2020-01-27","2020-09-10","2020-09-10","2021-04-29","2021-04-29","2020-05-28","2020-04-14","2020-04-14","2020-04-14","2020-05-28","2020-10-03","2020-10-03","2020-10-03","2020-10-03","2020-10-03","2020-10-03","2020-10-03","2021-12-11","2021-12-11","2020-03-24","2020-05-28","2020-05-28","2021-05-28","2021-05-28","2021-05-28","2021-05-28","2021-06-04","2021-06-04","2020-01-27","2020-05-28","2020-05-28","2020-05-28","2020-12-07","2021-02-16","2021-02-16","2020-01-27","2019-04-03","2019-11-08","2019-11-08","2019-01-29","2019-04-25","2019-04-25"],"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":[["","68462019005","NAPROXEN","TAB 500MG","20","Select","Select",""],["","67877032005","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","15","Select","Select",""],["","08373982700","OPTICHAMBER","MIS DIA LG","2","Select","Select",""],["","59310057922","PROAIR","AER ","17","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","17","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":""}]}]}