{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   ANALOSOSOMAL N","gend":1,"add":"SFLUG 8094RIC MAERT","city":"VIRGINIA BEACH","state":"VA","zip":"23464-9998","dob":"2005-02-04","age":"","mstatus":"","insh":"6792210*09","cliId":"","pno":"72\/7577732-4","cno":"","email":"","ename":"","eno":"","pphy":"FRAZER, JULIA PAIGE MD","ppno":"757\/461-6342","pcpadd":"STE 200 885 KEMPSVILLE RD","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23502,"pcpcounty":"","pcpid":"","pcpname":"CMG - Children's Hospital of The King's Daughters - Pediatric Specialists - Kempsville Office","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":["F43.22","G43.019","F41.8","Z79.899","F41.9","F32.9","G43.909","Z71.89","G43.009","R41.840","R06.83","R51.9","R05.","Z20.822","F43.23","J02.0","Z20.828","R41.3","R41.843","R41.844","B27.90","L29.9","Z23.","R21.","Z09.","Z60.0","J06.9","F43.20","R11.2","Z00.121","L23.7","Z68.52","Z13.31","Z71.3","Z72.821","Z71.82","L70.9","R45.88"],"date":["2020-11-05","2021-02-25","2021-02-25","2021-02-25","2021-09-08","2021-09-08","2021-09-08","2021-09-08","2021-04-13","2021-08-10","2021-02-15","2021-02-26","2021-02-26","2022-07-20","2020-08-17","2021-10-06","2021-10-04","2021-04-13","2021-04-13","2021-03-30","2021-11-02","2021-10-20","2021-11-02","2021-11-02","2021-11-02","2021-11-04","2022-07-20","2021-08-20","2020-06-30","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2022-04-27","2022-10-28"],"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":[["","45802073684","CLINDAMY\/BEN","GEL 1.2-5%","60","Select","Select",""],["","65862052730","VENLAFAXINE","CAP 37.5 ER","90","Select","Select",""],["","00093506001","HYDROXYZ","TAB 10MG","60","Select","Select",""],["","45802042578","FEXOFENADINE","TAB 60MG","30","Select","Select",""],["","55111029209","SUMATRIPTAN","TAB 50MG","18","Select","Select",""],["","68462029201","VERAPAMIL","TAB 120MG ER","30","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":""}]}]}