{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SINCERE   N PRICE","gend":0,"add":"1411 OAKHURST LANE                                          ","city":"RICHMOND                      ","state":"VA","zip":"23225-2807","dob":"2002-06-16","age":"","mstatus":"","insh":10050372,"cliId":"","pno":9176458624,"cno":8049245273,"email":"","ename":"","eno":"","pphy":"BELL, SANDRA A","ppno":"","pcpadd":"101 Cowardin Ave Ste 302,Ste 101","pcpcity":"Richmond                      ","pcpstate":"VA","pcpzip":232242078,"pcpcounty":"","pcpid":"P0129007","pcpname":"MANCHESTER PEDIATRICS ASSOCIATES","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"1411 OAKHURST LANE                                          ","madd2":"                                                            ","madd3":"","mcity":"RICHMOND                      ","mstate":"VA","mzip":"23225-2807","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J45.50","L30.9","Z68.52","R05","J45.51","J30.9","R06.83","Z91.14","R06.02","J45.901","J02.9","Z79.51","J45.41","J32.9","J45.998","Z77.22","R09.02","L20.9","J45.52","F90.9","Z20.828","E86.0","Z91.010","Z91.19","Z91.012","Z91.011","Z91.013","Z91.018","J45.902","R06.00","J34.1","K21.9","G47.10","G47.33","R09.81","J45.909","Z03.818","Z00.00","L20.84","Z71.89","Z71.41","Z71.6","R06.2","Z76.0","Z79.899","S30.0XXA","M54.5","Y04.0XXA","Z02.89","Z79.52","Z00.8","S20.221A","X58.XXXA"],"date":["2021-01-22","2021-01-04","2021-01-22","2021-06-05","2021-06-22","2020-08-12","2020-08-13","2020-05-19","2021-09-19","2021-09-19","2019-10-09","2021-09-19","2021-06-22","2020-08-13","2020-04-09","2020-05-14","2020-05-19","2020-05-20","2020-05-20","2020-05-20","2021-01-04","2020-05-19","2020-05-19","2020-05-19","2020-05-19","2020-05-19","2020-05-19","2020-05-19","2020-05-19","2020-05-19","2020-05-19","2020-06-01","2020-08-13","2020-08-13","2020-08-13","2021-09-09","2020-09-28","2021-01-22","2021-01-22","2021-01-22","2021-01-22","2021-01-22","2021-09-09","2021-04-13","2021-09-09","2021-09-09","2021-09-09","2021-09-09","2021-09-09","2021-09-09","2021-09-09","2021-09-09","2021-09-09"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","76204060060","IPRATROPIUM\/","ALBUTER","180","Select","Select",""],["","00487950160","ALBUTEROL","0.08%","540","Select","Select",""],["","45802005536","TRIAMCINOLON","0.10%","400","Select","Select",""],["","00173068220","VENTOLIN","","36","Select","Select",""],["","00085461001","DULERA","200-5MCG","13","Select","Select",""],["","60505083001","MOMETASONE","50MCG","17","Select","Select",""],["","31722072690","MONTELUKAST","10MG","30","Select","Select",""],["","45802065087","LORATADINE","10MG","30","Select","Select",""],["","00591544305","PREDNISONE","20MG","15","Select","Select",""],["","68382050010","OMEPRAZOLE","40MG","30","Select","Select",""],["","00904582460","VITAMIN","1000UNIT","30","Select","Select",""],["","66685100100","AMOX\/K","875-125","20","Select","Select",""],["","00135061502","FLONASE","27.5MCG","5.9","Select","Select",""],["","00173088101","NUCALA","100MG","1","Select","Select",""],["","76204060060","IPRATROPIUM\/ ","SOL ALBUTER","180","Select","Select",""],["","00487950160","ALBUTEROL ","NEB 0.00083","540","Select","Select",""],["","45802005536","TRIAMCINOLON ","OIN 0.001","400","Select","Select",""],["","00173068220","VENTOLIN ","AER ","36","Select","Select",""],["","00085461001","DULERA ","AER 200-5MCG","13","Select","Select",""],["","60505083001","MOMETASONE ","SPR 50MCG","17","Select","Select",""],["","31722072690","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","45802065087","LORATADINE ","TAB 10MG","30","Select","Select",""],["","00591544305","PREDNISONE ","TAB 20MG","15","Select","Select",""],["","68382050010","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","00904582460","VITAMIN ","TAB 1000UNIT","30","Select","Select",""],["","66685100100","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","00135061502","FLONASE ","SUS 27.5MCG","5.9","Select","Select",""],["","00173088101","NUCALA ","INJ 100MG","1","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}