{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRIAUNA   L KEELING","gend":1,"add":"365 BEASLEY LANE","city":"MARION                        ","state":"VA","zip":"24354-6816","dob":"2004-08-27","age":"","mstatus":"","insh":4181664,"cliId":"","pno":2762235204,"cno":"","email":"","ename":"","eno":"","pphy":"HARDEN, AMY J","ppno":2767832511,"pcpadd":"1204 N Main St,","pcpcity":"Marion                        ","pcpstate":"VA","pcpzip":243544312,"pcpcounty":"","pcpid":"","pcpname":"MOUNTAINVIEW PEDIATRICS PC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":"","add2":"365 BEASLEY LANE","add3":"","madd1":"365 BEASLEY LANE","madd2":"APARTMENT A","madd3":"","mcity":"MARION                        ","mstate":"VA","mzip":"24354-6816","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F91.3","R50.9","R11.10","R06.02","B07.9","R09.89","B85.0","Z30.42","Z30.09","Z83.3","Z00.129","Z30.9","Z01.00","Z23","H04.123","H47.323","B07.8","L53.8","R20.8","R23.8","R76.8","R89.9","I73.89","L25.9","L23.7"],"date":["2021-02-19","2020-07-14","2020-07-14","2020-07-14","2021-01-13","2020-08-14","2020-08-14","2021-11-19","2020-08-14","2020-08-14","2021-06-30","2021-08-05","2021-06-30","2020-12-14","2020-12-11","2020-12-11","2021-04-13","2021-04-13","2021-04-13","2021-04-13","2021-05-13","2021-05-13","2021-05-13","2021-07-12","2021-07-28"],"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":[["","59762453701","MEDROXYPR","INJ 150MG\/ML","1","Select","Select",""],["","47781030801","NITROFUR","CAP 100MG","20","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","20","Select","Select",""],["","43386035801","HYDROCO\/APAP","TAB 10-325MG","16","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","68180012101","CEPHALEXIN","CAP 250MG","60","Select","Select",""],["","69842090001","FLUTICASONE","SPR 50MCG","15.8","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","30","Select","Select",""],["","50742064601","TRIAZOLAM","TAB 0.25MG","1","Select","Select",""],["","68462053670","IMIQUIMOD","CRE 0.05","12","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","10","Select","Select",""],["","45802091987","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","00168000615","TRIAMCINOLON","OIN 0.001","30","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","9","Select","Select",""],["","28595057004","SPINOSAD","SUS 0.009","120","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":""}]}]}