{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GRACE   E FLECTHER","gend":1,"add":"201 WOODROOF ROAD","city":"NEWPORT NEWS                  ","state":"VA","zip":"23606-2928","dob":"2003-06-23","age":"","mstatus":"","insh":4200417,"cliId":"","pno":7575083156,"cno":"","email":"","ename":"","eno":"","pphy":"CURD, LEWIS H","ppno":"","pcpadd":"11783 Rock Landing Dr Ste 202,","pcpcity":"Newport News                  ","pcpstate":"VA","pcpzip":236064431,"pcpcounty":"","pcpid":"","pcpname":"CHILDRENS MEDICAL GROUP NEWPORT NEWS PEDIATRICS","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"TIDEWATER","aligned":"","ano":"","add2":"201 WOODROOF ROAD","add3":"","madd1":"201 WOODROOF ROAD","madd2":"","madd3":"","mcity":"NEWPORT NEWS                  ","mstate":"VA","mzip":"23606-2928","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z79.899","F43.21","L70.0","Z13.31","L74.510","Z01.419","Z30.430","Z32.02","L00","Z30.431","K13.0","L74.519","Z00.00","Z71.3","Z13.39","Z23","Z68.44","Z71.82","Z11.3","R42","D72.829","M79.10","R52","R50.9","Z20.822","A41.9","J96.01","N39.0","R65.20","N61.0","F32.9","F41.0","F41.9","Z88.1","L29.9","Z97.5","E83.42","T36.8X5A","L03.313","F43.23","L08.9","N64.4","R00.0","R94.31","R06.02","L03.90","R06.00","L02.91","Z01.411","Z11.4","K59.00","N30.00","B96.89","F33.1","N94.6","Z30.09","R11.0","Z30.013"],"date":["2021-08-08","2021-07-22","2021-07-21","2021-07-27","2021-07-21","2020-12-15","2020-12-28","2022-03-22","2021-01-08","2021-01-27","2021-04-14","2021-04-14","2021-07-27","2021-07-27","2021-07-27","2021-08-27","2021-07-27","2021-07-27","2021-08-06","2021-08-07","2021-08-07","2021-08-07","2021-08-07","2021-08-10","2021-11-12","2021-08-10","2021-08-08","2021-08-10","2021-08-08","2021-08-24","2021-08-08","2021-08-08","2021-08-08","2021-08-08","2021-08-08","2021-08-08","2021-08-08","2021-08-08","2021-08-10","2021-08-10","2021-08-08","2022-01-27","2021-08-08","2021-08-08","2021-08-10","2021-08-10","2021-08-10","2021-08-24","2022-01-27","2022-01-27","2022-03-22","2022-03-22","2022-03-22","2019-02-06","2019-04-17","2019-04-17","2019-04-30","2019-05-01"],"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":[["","65862042005","SMZ\/TMP","TAB 800-160","14.00","Select","Select",""],["","24385067510","MAG","SOL LEMON","300.00","Select","Select",""],["","00135009070","CITRUCEL","POW SF ORANG","479","Select","Select",""],["","68001040008","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","68382013814","TOPIRAMATE","TAB 25MG","60","Select","Select",""],["","68462013801","OXCARBAZEPIN","TAB 300MG","60","Select","Select",""],["","00023114501","BOTOX","INJ 100UNIT","1","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","55111028130","LEVOFLOXACIN","TAB 750MG","10","Select","Select",""],["","00143211250","DOXYCYCL","TAB 100MG","20","Select","Select",""],["","61748030313","MYORISAN","CAP 30MG","30","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0.3","Select","Select",""],["","13668000901","CITALOPRAM","TAB 10MG","30","Select","Select",""],["","50102020013","TULANA","TAB 0.35MG","28","Select","Select",""],["","68462030329","HEATHER","TAB 0.35MG","28","Select","Select",""],["","42806016101","HYDROXYZ","TAB 50MG","60","Select","Select",""],["","00555105686","CLARAVIS","CAP 30MG","30","Select","Select",""],["","24385027403","HYDROCORT\/","CRE ALOE 1%","28.4","Select","Select",""],["","68382080501","TRAZODONE","TAB 50MG","30","Select","Select",""],["","68180084013","NORGEST\/ETHI","TAB 0.25\/35","28","Select","Select",""],["","67457088799","MEDROXYPR","INJ 150MG\/ML","1","Select","Select",""],["","45802045384","ADAPALENE","CRE 0.001","45","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":""}]}]}