{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"W O   LUAPRJ KCIRRA","gend":0,"add":"2 4121TS HT7","city":"NEWPORT NEWS","state":"VA","zip":"23607-9998","dob":"2003-09-20","age":"","mstatus":"","insh":"8320110*45","cliId":"","pno":"42\/7572780-5","cno":"","email":"","ename":"","eno":"","pphy":"STAPLETON, MACY LERIN NP","ppno":"757\/838-8166","pcpadd":"2101 EXECUTIVE DRIVE SUITE 160","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":"","pcpname":"ASSOCIATES IN PEDIATRIC CARE-HAMPTON LLC","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":["R19.7","K59.4","K62.5","R63.4","J30.5","K52.29","J30.2","R06.7","R03.0","Z68.43","J30.89","K52.89","F43.8","K61.0","L25.9","K62.89","F32.0","Z13.31","Z00.121","Z71.3","Z71.82","B36.0","L83.","R22.2","Z23.","Z13.89","I10.","E66.01","R63.5","R51.9","R10.9","R11.10","R63.1","R35.8","M54.5","L02.91","R79.82","Z82.69","R11.0","K90.0","Z20.828","M25.512","K21.9","F80.81","K58.9","F32.89","Z97.3","R94.6","Z78.9","R11.2","R55."],"date":["2022-02-07","2022-01-13","2021-07-08","2022-02-07","2021-11-15","2021-11-17","2021-11-17","2021-11-17","2021-03-12","2021-06-29","2021-11-10","2021-08-26","2021-09-08","2021-12-20","2022-01-03","2022-02-07","2021-12-20","2021-12-20","2021-08-30","2021-08-30","2021-08-30","2020-09-03","2020-11-04","2020-09-03","2021-08-30","2020-09-03","2021-01-14","2021-08-30","2021-01-21","2021-01-21","2021-07-27","2022-01-13","2021-06-29","2021-06-29","2021-09-27","2021-09-27","2022-02-07","2022-02-07","2021-07-06","2021-07-19","2022-09-26","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2020-11-04","2022-01-03","2022-01-03","2022-10-02"],"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":[["","00143122701","DICYCLOMINE","TAB 20MG","120","Select","Select",""],["","64980028203","MESALAMINE","SUP 1000MG","28","Select","Select",""],["","57237007810","ONDANSETRON","TAB 8MG ODT","8","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","68382004001","PROMETHAZINE","TAB 12.5MG","30","Select","Select",""],["","00713050324","ANUCORT-HC","SUP 25MG","28","Select","Select",""],["","45802005505","TRIAMCINOLON","OIN 0.001","454","Select","Select",""],["","68645014059","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","21","Select","Select",""],["","00143928501","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","","KETOCONAZOLE","SHA 0.02","","Select","Select",""],["","","OPTIMAL-D","CAP 50000UNT","","Select","Select",""],["","","VITAMIN","CAP 50000UNT","","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":""}]}]}