{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JACOREY PAGE","gend":0,"add":"702 APPOMATTOX STREET                                       ","city":"NORFOLK                       ","state":"VA","zip":"23523-1434","dob":"2003-02-20","age":"","mstatus":"","insh":10098722,"cliId":"","pno":7573671788,"cno":7572029932,"email":"","ename":"","eno":"","pphy":"AMIN, SANJAY M                                              ","ppno":"","pcpadd":"1529 International Blvd Ste 103","pcpcity":"Norfolk                       ","pcpstate":"VA","pcpzip":235134802,"pcpcounty":"","pcpid":"P9307428","pcpname":"NORFOLK PEDIATRICS PLLC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"TIDEWATER","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"702 APPOMATTOX STREET                                       ","madd2":"                                                            ","madd3":"","mcity":"NORFOLK                       ","mstate":"VA","mzip":"23523-1434","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L70.0","Z28.21","J10.1","Z71.9","Z00.121","Z68.53","Z23","R94.118","Z13.31","Z71.3","R45.89","Z71.82","G43.909","R51","M25.561","T14.90XA","S82.101A","M25.569","X50.9XXA","Y93.61","S89.91XA","M25.461","S99.919A","T14.8XXA","M79.89","S82.151A","X50.0XXA","Y92.321","W18.39XA","S82.151D","W18.39XD","S62.232A","M79.642","S62.231A","W19.XXXA","Y93.83","W51.XXXA","S62.512A","X58.XXXA","Y92.9","S62.232D","Z00.129","Z28.82","Z68.52","R10.13","R10.9","R11.2","R19.7","R05","R10.33","A74.9","R30.0","Z11.3","Z00.01"],"date":["2021-05-04","2021-05-24","2019-03-18","2021-05-04","2019-07-22","2019-07-22","2020-10-02","2019-07-22","2021-10-29","2021-10-29","2019-07-22","2020-10-02","2019-07-29","2019-07-29","2019-09-08","2019-09-07","2019-09-08","2019-09-07","2019-09-07","2019-09-08","2019-09-07","2019-09-07","2019-09-07","2019-09-07","2020-04-23","2019-09-08","2019-09-08","2019-09-08","2020-04-23","2020-03-02","2020-03-02","2020-04-28","2020-04-23","2020-04-27","2020-04-27","2020-04-27","2020-04-28","2020-04-28","2020-04-28","2020-04-28","2020-06-01","2020-10-02","2020-10-02","2021-10-29","2021-03-11","2021-03-11","2021-03-11","2021-03-11","2021-03-11","2021-03-11","2021-10-29","2021-09-13","2021-10-29","2021-10-29"],"priorHcc":["","","","","","","","",null,null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","",null,"",null,null]}},{"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":[["","00378808245","TRETINOIN","0.03%","45","Select","Select",""],["","49884072703","DOXYCYC","100MG","30","Select","Select",""],["","45802073684","CLINDAMY\/BEN","1.2-5%","45","Select","Select",""],["","45802028001","BENZOYL","5% WASH","142","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","10","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","20","Select","Select",""],["","51224012230","AZITHROMYCIN","500MG","2","Select","Select",""],["","00378808245","TRETINOIN ","CRE 0.00025","45","Select","Select",""],["","49884072703","DOXYCYC ","CAP 100MG","30","Select","Select",""],["","45802073684","CLINDAMY\/BEN ","GEL 1.2-5%","45","Select","Select",""],["","45802028001","BENZOYL ","LIQ 5% WASH","142","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","10","Select","Select",""],["","51224012250","AZITHROMYCIN ","TAB 500MG","2","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","20","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","",""],["N\/A","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":""}]}]}