{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"S   HAYIKARNOSDRAHCIR ","gend":1,"add":"SMAILLIW 004004 TPA STC ","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"2003-01-07","age":"","mstatus":"","insh":"8734810*32","cliId":"","pno":"83\/7571452-1","cno":"757\/358-5690","email":"","ename":"","eno":"","pphy":"SIMON, KRISTEN WATERFIELD MD","ppno":"757\/668-6700","pcpadd":"2088 PRINCESS ANNE RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23456,"pcpcounty":"","pcpid":"","pcpname":"CMG - Children's Hospital of The King's Daughters - General Booth Pediatrics","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":["F90.2","V62.84","Z91.5","F32.2","F34.81","F33.9","Z62.820","F32.9","F41.1","F90.9","F91.3","T14.91XD","J30.9","J03.90","R05.9","R11.2","Z20.822","R09.81","Z87.09","V62.85","E66.9","Z68.54","K59.00","F32.3","T50.901A","Z86.59","E66.01","Z68.43","N30.00","Z20.828","T50.902A","R21.","F32.1","J45.20","R32.","K22.4","U07.1","B34.9","L70.8","R06.02","F33.1","A08.8","E11.9","J45.909","M25.571","R51."],"date":["2021-02-01","2020-09-28","2020-09-28","2020-05-31","2021-02-01","2020-09-29","2020-10-22","2021-03-04","2020-10-22","2020-09-28","2020-09-28","2020-09-28","2020-10-04","2021-09-10","2021-12-27","2021-12-27","2021-12-27","2021-12-27","2021-12-27","2020-09-11","2020-11-27","2020-05-26","2020-05-26","2020-05-29","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2020-09-27","2020-01-15","2020-04-02","2020-09-29","2020-01-14","2020-04-06","2021-08-12","2021-08-12","2020-09-12","2020-09-13","2020-04-02","2020-05-30","2020-11-27","2020-09-11","2019-09-17","2019-03-22"],"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":[["","67877043103","ARIPIPRAZOLE","TAB 5MG","30","Select","Select",""],["","23155010210","METFORMIN","TAB 500MG","62","Select","Select",""],["","68462013801","OXCARBAZEPIN","TAB 300MG","60","Select","Select",""],["","10702000350","PROMETHAZINE","TAB 25MG","20","Select","Select",""],["","68382080605","TRAZODONE","TAB 100MG","31","Select","Select",""],["","47469005964","MELATONIN","TAB 10MG CR","31","Select","Select",""],["","00054001925","PREDNISONE","TAB 50MG","7","Select","Select",""],["","57237002901","AMOXICILLIN","TAB 875MG","20","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":""}]}]}