{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   ANAEARNEDLOM S","gend":1,"add":"P XOB CFO541 XOB O","city":"SUFFOLK","state":"VA","zip":"23439-9998","dob":"2004-11-17","age":"","mstatus":"","insh":"6600110*35","cliId":"","pno":"18\/7579612-9","cno":"","email":"","ename":"","eno":"","pphy":"WAIDE, MELISSA NP","ppno":"757\/668-7007","pcpadd":"601 CHILDRENS LANE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23507,"pcpcounty":"","pcpid":"","pcpname":"CSG - Children's Hospital of The King's Daughters - Nephrology","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":["Z94.0","T86.11","Z79.899","N18.1","N18.9","Z84.0","M25.561","I10.","N13.70","N13.30","I12.9","NO DATA","E55.9","N25.0","N28.89","D63.1","Z01.812","Z20.822","L70.9","Z46.6","J45.909","I15.1","D50.9","N18.2","Z82.61","Z82.5","Z83.3","Z82.49","Z84.1","Z82.3","Z84.89","R79.89","N93.9","N18.6","P07.35","M89.8X9","Z99.2","I15.8","P04.18","R94.4","V58.89","D68.2","D64.9","D89.9","Z45.2","Z95.828","Z83.42","Z84.2","T86.91","Z51.81","V58.69"],"date":["2022-07-07","2022-08-04","2022-08-04","2021-06-23","2022-08-04","2021-05-18","2021-05-18","2022-01-07","2021-09-09","2022-02-14","2022-02-14","2022-08-04","2021-12-10","2021-12-10","2022-05-18","2022-08-04","2022-02-14","2022-02-14","2021-05-13","2022-02-14","2022-02-14","2021-07-23","2021-07-23","2021-07-23","2021-07-23","2021-07-23","2021-07-23","2021-07-23","2021-07-23","2021-07-23","2021-07-23","2021-09-08","2021-07-02","2020-08-15","2020-08-15","2020-08-15","2021-04-06","2020-08-15","2020-08-15","2021-03-10","2022-07-07","2021-01-08","2021-01-08","2021-01-13","2021-03-22","2021-04-06","2021-04-06","2021-04-06","2021-04-06","2021-04-06","2021-03-13"],"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":[]},{"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":[["","00245010810","FERROUS","TAB 325MG EC","60","Select","Select",""],["","49483034150","ACETAMINOPHN","TAB 500MG","30","Select","Select",""],["","54629041120","VITAMIN","TAB 2000UNIT","30","Select","Select",""],["","00781206705","MYCOPHENOLAT","CAP 250MG","180","Select","Select",""],["","65862075360","VALGANCICLOV","TAB 450MG","60","Select","Select",""],["","59779048462","PAIN","TAB 500MG","30","Select","Select",""],["","00597003134","CATAPRES-TTS","DIS 0.1\/24HR","12","Select","Select",""],["","45802048678","DOCUSATE","CAP 100MG","6","Select","Select",""],["","00054472831","PREDNISONE","TAB 5MG","30","Select","Select",""],["","00781210301","TACROLIMUS","CAP 1MG","240","Select","Select",""],["","62175011843","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","59779060016","CVS","TAB 81MG EC","90","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","65862041901","SMZ-TMP","TAB 400-80MG","13","Select","Select",""],["","68462010630","ONDANSETRON","TAB 8MG","10","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","5","Select","Select",""],["","49483048112","ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","50242007601","NUTROPIN","INJ 20MG\/2ML","8","Select","Select",""],["","00469061773","PROGRAF","CAP 1MG","240","Select","Select",""],["","00603020922","MAG","TAB 400MG","60","Select","Select",""],["","64980010401","PHOSPHA","TAB NEUTRAL","60","Select","Select",""],["","00004025901","CELLCEPT","CAP 250MG","150","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":""}]}]}