{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JACARI STROTHERS","gend":0,"add":"1109 FARRISH PLACE","city":"FREDERICKSBURG                ","state":"VA","zip":"22401-2678","dob":"2002-09-15","age":"","mstatus":"","insh":6896146,"cliId":"","pno":5403764886,"cno":"","email":"","ename":"","eno":"","pphy":"KOST PHILLIPS, JENNIFER R","ppno":5403688091,"pcpadd":"331 Park Hill Dr,Ste 101","pcpcity":"Fredericksburg                ","pcpstate":"VA","pcpzip":224013375,"pcpcounty":"","pcpid":"","pcpname":"PREFERRED PEDIATRICS AT SNOWDEN INC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"1109 FARRISH PLACE","add3":"","madd1":"1109 FARRISH PLACE","madd2":"","madd3":"","mcity":"FREDERICKSBURG                ","mstate":"VA","mzip":"22401-2678","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J02.0","R51","J02.9","L70.0","Z20.828","M54.2","R10.31","R11.10","R11.2","Z20.822","R10.84","Z03.818","R51.9","G43.C0","K21.00","E23.7","Z86.39","Z87.898","Z00.01","Z23","Z13.31","M47.812","M50.30","S16.1XXS","J06.9","U07.1","R50.9","G44.1"],"date":["2020-02-04","2020-02-04","2020-02-04","2021-07-30","2020-08-15","2021-09-16","2021-03-21","2021-03-21","2021-03-21","2021-12-22","2021-03-21","2021-03-21","2021-09-10","2021-05-19","2021-05-19","2021-05-19","2021-09-10","2021-09-10","2021-09-16","2021-09-16","2021-09-16","2021-11-05","2021-12-30","2021-11-05","2021-12-24","2021-12-24","2021-12-24","2021-12-24"],"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":[["","00832105410","BACLOFEN","TAB 10MG","60","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","16571020210","DICLOFENAC","TAB 50MG DR","60","Select","Select",""],["","24658031205","DOXYCYCL","TAB 100MG","60","Select","Select",""],["","65162018910","NAPROXEN","TAB 375MG","60","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","20","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","21","Select","Select",""],["","69097012203","TOPIRAMATE","TAB 25MG","60","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","8","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","00574222520","TRETINOIN","CRE 0.00025","20","Select","Select",""],["","59762374401","CLINDAMYCIN","LOT 10MG\/ML","60","Select","Select",""],["","67405082505","BENZOYL","LIQ 5% WASH","148","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","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":""}]}]}