{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  YNATTIRBSSELRAH A ","gend":1,"add":"TSIRB 80321NL ENOC EL","city":"RUTHER GLEN","state":"VA","zip":"22546-9998","dob":"1993-05-11","age":"","mstatus":"","insh":"7314610*18","cliId":"","pno":"03\/4087190-6","cno":"","email":"","ename":"","eno":"","pphy":"VALMORES, PHILIP P DO","ppno":"804\/730-4690","pcpadd":"SUITE 100 7347 BELL CREEK RD","pcpcity":"MECHANICSVILLE","pcpstate":"VA","pcpzip":23111,"pcpcounty":"","pcpid":"","pcpname":"BON SECOURS PEDIATRICS OF RICHMOND","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","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":["NO DATA","M51.36","M54.41","J45.909","K21.9","F41.9","U07.1","Z20.828","R00.0","Z20.822","R05.9","J45.51","E66.01","Z68.39","R09.02","F12.90","Z72.0","Z88.0","Z88.1","Z79.51","R06.2","Z11.59","M53.86","M54.5","S33.5XXA","M54.30","M25.511","F90.0","M54.2","M54.12","S13.4XXA","M51.16","J45.901","B34.9","R07.89","R07.9","J80.","R06.02","J98.2","D64.9","J45.50","E66.9","M51.26","Z48.89","I49.1","R94.31","V58.89","M75.101","S43.431S","M75.01","R10.9","R11.2","F41.0","T50.995A","R06.89","R11.0","J45.998","Z11.52","M54.31","G89.29","Z79.82","Z79.52","Z79.1","Z86.32","Z87.440","Z87.891","Z80.9","Z83.3","J44.9","R45.7","T78.2XXA","T78.40XA","L50.9","L29.9","R10.31","S06.0X1A","S16.1XXA","N30.01","R10.32","V89.2XXA","Y92.89","Y93.89","T36.0X1A","N39.0","S09.90XA","S13.9XXA","T14.8XXA","F98.8","F07.81","R41.3","R51.","K92.1"],"date":["2020-08-25","2020-08-25","2020-08-25","2021-10-10","2020-08-25","2021-10-10","2021-11-23","2020-10-21","2021-08-21","2021-11-20","2021-11-20","2021-11-20","2021-10-10","2021-10-10","2021-10-10","2021-10-10","2021-10-10","2021-10-10","2021-10-10","2021-10-10","2021-10-10","2021-11-20","2021-07-21","2021-07-21","2021-07-21","2021-07-21","2021-07-21","2021-07-09","2020-06-05","2021-12-03","2020-06-05","2020-08-25","2021-10-10","2021-11-16","2021-05-29","2021-05-29","2021-05-29","2021-08-21","2021-08-21","2021-08-21","2021-10-10","2021-10-10","2020-11-04","2020-11-04","2021-10-10","2021-10-10","2021-12-03","2021-12-03","2021-10-22","2021-12-03","2020-05-05","2020-05-05","2021-01-11","2021-01-11","2021-02-13","2021-11-23","2021-11-23","2021-11-23","2020-08-25","2020-08-25","2020-08-25","2020-08-25","2020-08-25","2020-08-25","2020-08-25","2020-08-25","2020-08-25","2020-08-25","2021-08-21","2021-08-21","2019-12-13","2019-12-13","2019-12-13","2019-12-13","2019-03-19","2019-08-09","2019-08-09","2019-08-09","2019-08-09","2019-08-09","2019-08-09","2019-08-09","2019-12-13","2019-04-07","2019-08-02","2019-08-02","2019-08-02","2019-02-07","2019-11-04","2019-11-04","2019-11-04","2019-11-04"],"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":[["","00228306011","AMPHET\/DEXTR","CAP 20MG ER","30","Select","Select",""],["","00378967130","IPRATROPIUM\/","SOL ALBUTER","90","Select","Select",""],["","54092038701","ADDERALL","CAP 20MG","30","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","42806016005","HYDROXYZ","TAB 25MG","15","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","","CIPROFLOXACN","TAB 500MG","","Select","Select",""],["","00093742698","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","00143973805","PREDNISONE","TAB 20MG","14","Select","Select",""],["","","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","00832105410","BACLOFEN","TAB 10MG","60","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","6","Select","Select",""],["","67877032005","IBUPROFEN","TAB 600MG","15","Select","Select",""],["","00173072020","FLOVENT","AER 220MCG","12","Select","Select",""],["","69543025116","VIRTUSSIN","LIQ 100-10\/5","50","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","15","Select","Select",""],["","00591565810","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","69097081507","GABAPENTIN","CAP 400MG","30","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","30","Select","Select",""],["","16571020210","DICLOFENAC","TAB 50MG DR","60","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","30","Select","Select",""],["","00093081101","NORTRIPTYLIN","CAP 25MG","30","Select","Select",""],["","","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","75826011510","PHENAZOPYRID","TAB 200MG","6","Select","Select",""],["","","METHYLPRED","TAB 4MG","","Select","Select",""],["","00603158658","PROMETHAZINE","SYP DM","120","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","00781185220","AMOX\/K","TAB 875-125","14","Select","Select",""],["","49502050002","EPIPEN","INJ 0.3MG","2","Select","Select",""],["","33332031901","AFLURIA","INJ 2019-20","0","Select","Select",""],["","00597002402","COMBIVENT","AER 20-100","4","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","51991081403","AZELASTINE","SPR 0.001","30","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","14","Select","Select",""],["","71093014005","METHOCARBAM","TAB 500MG","20","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","20","Select","Select",""],["","00115169449","EPINEPHRINE","INJ 0.3MG","2","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":""}]}]}