{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KRISHA PATEL","gend":1,"add":"3622 JEFFERSON DAVIS HIGHWAY                                ","city":"RICHMOND                      ","state":"VA","zip":"23234-2628","dob":"2002-11-24","age":"","mstatus":"","insh":10100104,"cliId":"","pno":8043325411,"cno":8043325411,"email":"","ename":"","eno":"","pphy":"CREWE, STEPHANIE                                            ","ppno":"","pcpadd":"1001 E Marshall St","pcpcity":"Richmond                      ","pcpstate":"VA","pcpzip":232985075,"pcpcounty":"","pcpid":"P9059173","pcpname":"VCUHS CHILDRENS PAVILION","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"3622 JEFFERSON DAVIS HIGHWAY                                ","madd2":"                                                            ","madd3":"","mcity":"RICHMOND                      ","mstate":"VA","mzip":"23234-2628","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["ASIAN\/PACIFIC"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N91.5","Z30.011","L70.9","E28.2","N92.6","Z02.89","R10.9","Z23","S63.92XA","R51","M54.5","Z00.01","Z13.220","Z11.8","H66.001","J01.10","E78.1","Z71.3","Z78.9","D50.8","L65.9","B07.0","M77.42","M77.41","M79.672","M79.671","Z00.129","F41.0","Z20.828","R68.89","L03.111","L70.0","Z68.24","G44.209","J02.9","R05","H92.03","H60.593","J03.90","R68.83","Z20.822","Z68.52"],"date":["2019-01-16","2019-01-16","2019-01-16","2021-07-07","2020-08-18","2019-01-28","2019-03-18","2021-07-07","2019-05-10","2019-09-18","2021-03-12","2019-11-12","2019-11-12","2021-03-12","2019-12-10","2019-12-10","2021-07-07","2021-07-07","2021-09-17","2021-07-07","2020-08-18","2020-08-18","2020-07-08","2020-07-08","2020-07-08","2020-07-08","2020-08-18","2021-07-07","2020-08-31","2020-08-31","2020-09-30","2021-07-07","2020-12-23","2021-04-01","2021-09-16","2021-09-16","2021-09-16","2021-09-17","2021-09-17","2021-09-17","2021-09-17","2021-09-17"],"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":[["","68645052254","SERTRALINE","50MG","90","Select","Select",""],["","67877021905","CEPHALEXIN","500MG","40","Select","Select",""],["","00904759080","FEROSUL","325MG","90","Select","Select",""],["","67877041301","METFORMIN","500MG ER","90","Select","Select",""],["","00430042014","LO","10\/1\/10","28","Select","Select",""],["","81131074933","IRON","325MG","30","Select","Select",""],["","00781726368","CLINDAMY\/BEN","1-5%","50","Select","Select",""],["","43547028111","ESCITALOPRAM","10MG","90","Select","Select",""],["","00904759180","FERROUS","325MG","30","Select","Select",""],["","00000000000","","","90","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","59746017509","PREDNISONE","20MG","15","Select","Select",""],["","68645052254","SERTRALINE ","TAB 50MG","90","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","40","Select","Select",""],["","00904759080","FEROSUL ","TAB 325MG","90","Select","Select",""],["","67877041301","METFORMIN ","TAB 500MG ER","90","Select","Select",""],["","00430042014","LO ","TAB 40452","28","Select","Select",""],["","81131074933","IRON ","TAB 325MG","30","Select","Select",""],["","00781726368","CLINDAMY\/BEN ","GEL 1-5%","50","Select","Select",""],["","43547028111","ESCITALOPRAM ","TAB 10MG","90","Select","Select",""],["","00904759180","FERROUS ","TAB 325MG","30","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","59746017509","PREDNISONE ","TAB 20MG","15","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","",""],["Yes","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":""}]}]}