{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DALTON BURTON","gend":0,"add":"727 PAYNE ROAD","city":"CLEAR BROOK                   ","state":"VA","zip":"22624-1703","dob":"2003-12-20","age":"","mstatus":"","insh":4295968,"cliId":"","pno":5405356851,"cno":5406671711,"email":"","ename":"","eno":"","pphy":"DANSIE, CHAD L","ppno":5406671727,"pcpadd":"190 Campus Blvd Ste 400,","pcpcity":"Winchester                    ","pcpstate":"VA","pcpzip":226012872,"pcpcounty":"","pcpid":"","pcpname":"WINCHESTER PEDIATRIC CLINIC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"NORTHERN\/ WINCHESTER","aligned":"","ano":"","add2":"727 PAYNE ROAD","add3":"","madd1":"727 PAYNE ROAD","madd2":"","madd3":"","mcity":"CLEAR BROOK                   ","mstate":"VA","mzip":"22624-1703","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R06.2","J06.9","R50.9","Z87.09","F41.1","G47.33","J45.40","K21.9","Z00.129","Z23","Z91.018","J45.50","J30.1","J30.89","J30.81","L73.9","G25.81","G47.21","E66.9","F51.3","J45.909","F41.9","J30.2","R49.9","F32.9","F43.20","J32.9","B97.89","Z11.59","L20.89","L85.8","J45.51","E66.01","F90.0","H53.149","F19.20"],"date":["2020-01-21","2021-12-18","2020-01-21","2020-01-21","2021-12-23","2021-07-09","2021-07-09","2021-01-12","2020-05-04","2020-05-04","2021-07-09","2021-09-08","2021-03-18","2021-03-18","2021-03-18","2021-01-11","2021-01-12","2021-01-12","2021-01-12","2021-01-12","2021-01-12","2021-01-12","2021-01-12","2021-01-12","2021-12-16","2021-02-08","2021-02-22","2021-02-22","2021-03-18","2021-04-29","2021-04-29","2021-06-30","2021-07-09","2021-10-08","2021-07-27","2021-10-08"],"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":[["","00093317431","ALBUTEROL","FAT E","8.5","Select","Select",""],["","70954005920","PREDNISONE","TAB 10MG","30","Select","Select",""],["","16729020201","BUSPIRONE","TAB 10MG","60","Select","Select",""],["","43547028810","BUPROPION","TAB 100MG SR","30","Select","Select",""],["","00597010061","SPIRIVA","SPR 2.5MCG","4","Select","Select",""],["","00597008717","ATROVENT","AER 17MCG","12.9","Select","Select",""],["","00085461001","DULERA","AER 200-5MCG","13","Select","Select",""],["","65162071110","GUANFACINE","TAB 1MG","30","Select","Select",""],["","68180016006","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","13668042990","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","00378967130","IPRATROPIUM\/","SOL ALBUTER","180","Select","Select",""],["","00168000615","TRIAMCINOLON","OIN 0.001","15","Select","Select",""],["","16714008110","HYDROXYZ","TAB 10MG","120","Select","Select",""],["","57237001760","DULOXETINE","CAP 20MG","30","Select","Select",""],["","43547048710","METHYLPHENID","TAB 10MG","30","Select","Select",""],["","49502010202","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","45802026937","PERMETHRIN","CRE 0.05","60","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","20","Select","Select",""],["","59310057922","PROAIR","AER ","8.5","Select","Select",""],["","00121075908","PREDNISOLONE","SOL 15MG\/5ML","67","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":""}]}]}