{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JASMINE   D RODRIGUEZ ALVAREZ","gend":1,"add":"3177 WESTWIND DRIVE","city":"ROCKINGHAM                    ","state":"VA","zip":"22801-9103","dob":"2003-06-07","age":"","mstatus":"","insh":4591728,"cliId":"","pno":5404355422,"cno":5407421750,"email":"","ename":"","eno":"","pphy":"GERBER, AMANDA L","ppno":5404374800,"pcpadd":"4059 Quarles Ct,","pcpcity":"Rockingham                    ","pcpstate":"VA","pcpzip":228018717,"pcpcounty":"","pcpid":"","pcpname":"BLUESTONE PEDIATRICS PLC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"3177 WESTWIND DRIVE","add3":"","madd1":"3177 WESTWIND DRIVE","madd2":"","madd3":"","mcity":"ROCKINGHAM                    ","mstate":"VA","mzip":"22801-9103","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F32.89","F41.9","F33.1","F32.1","N89.8","F98.8","F32.9","R55","Z11.3","Z11.59","J02.0","J02.9","H92.09","B95.5","J03.00","R13.10","R10.11","A64","T19.2XXA","Z20.2","X58.XXXA","Z97.5","Z79.899","S30.814A","K80.50","K85.10","N30.00","K80.62","K76.0","Z79.3","Z20.822","K80.20","R74.8","E80.6","R93.3","K83.8","K80.10","K81.9","A60.04","Z01.419","J11.1","R41.840"],"date":["2020-03-19","2020-02-13","2020-01-16","2020-01-30","2021-05-26","2020-02-13","2020-02-13","2020-07-08","2020-07-31","2020-07-31","2020-08-27","2020-08-30","2020-08-27","2020-08-27","2020-08-30","2020-08-30","2021-08-31","2021-05-26","2021-08-19","2021-08-19","2021-08-19","2021-08-19","2021-08-29","2021-08-19","2021-09-02","2021-09-03","2021-09-01","2021-08-29","2021-08-30","2021-08-29","2021-08-29","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-09-02","2021-09-02","2021-10-25","2019-06-18","2019-12-18","2019-12-19"],"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":[["","13668013601","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","21","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","10","Select","Select",""],["","31722070530","VALACYCLOVIR","TAB 1GM","14","Select","Select",""],["","68180016106","AZITHROMYCIN","TAB 500MG","2","Select","Select",""],["","42858010250","OXYCOD\/APAP","TAB 5-325MG","12","Select","Select",""],["","10370010150","BUPROPN","TAB 150MG XL","30","Select","Select",""],["","00555901658","SPRINTEC","TAB 28 DAY","28","Select","Select",""],["","50428034138","MELATONIN","TAB 3MG","30","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","65162052110","PROMETHAZINE","TAB 25MG","3","Select","Select",""],["","59762500801","MISOPROSTOL","TAB 200MCG","4","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","10702001150","HYDROXYZ","TAB 25MG","60","Select","Select",""],["","51862058501","LORCET","TAB 5-325MG","6","Select","Select",""],["","50111064801","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","69097015807","MELOXICAM","TAB 7.5MG","20","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","10","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":""}]}]}