{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JELAYA   S RODGERS","gend":1,"add":"153 FAIRWIND DR APT 206","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"1999-05-05","age":"","mstatus":"","insh":"900037047*01","cliId":"9GW6PR5EW43","pno":"757\/469-9259","cno":"757\/469-9259","email":"","ename":"","eno":"","pphy":"KARP, GLENDA S MD","ppno":"757\/668-6500","pcpadd":"BLDG B 171 KEMPSVILLE RD","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23502,"pcpcounty":"","pcpid":120216,"pcpname":"CMG - Tidewater Children's Associates","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F90.0","F84.0","Z76.0","Z79.899","Z23.","H50.34","H50.17","Z00.00","R63.1","Z71.3","Z13.31","Z71.82","Z72.821","K59.00","E66.9","K59.09","Z68.31","J30.2","F98.8","F51.01","Z68.30","H93.8X2"],"date":["2021-03-02","2021-05-03","2021-03-02","2021-03-02","2021-03-12","2021-01-21","2021-01-21","2020-08-26","2020-08-26","2021-03-02","2020-08-26","2021-03-02","2020-08-26","2020-08-26","2021-03-02","2021-03-02","2021-05-03","2021-03-02","2021-11-17","2021-11-17","2021-11-17","2021-07-09"],"priorHcc":["","","","","","","","","","","","","","","","","","",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":[["","378815801","METHYLPHENID","TAB 54MG ER","-30","Select","Select",""],["","16714040604","LARIN FE","TAB 44216","28","Select","Select",""],["","555902658","JUNEL FE","TAB 44216","28","Select","Select",""],["","50458058701","CONCERTA","TAB 54MG","30","Select","Select",""],["","11822393550","RA LAXATIVE","POW ","238","Select","Select",""],["","11822331520","LORATADINE","TAB 10MG","30","Select","Select",""],["","135057602","FLONASE ALGY","SPR 50MCG","10","Select","Select",""],["","29300013601","CLONIDINE","TAB 0.2MG","30","Select","Select",""],["","60432026415","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","45802086802","POLYETH GLYC","POW 3350 NF","238","Select","Select",""],["","16714040803","LARIN","TAB 44216","21","Select","Select",""],["","29300013601","CLONIDINE HYDROCHLORIDE","","30","Select","Select",""],["","16714040803","LARIN 1\/20","","-21","Select","Select",""],["","555902658","JUNEL FE 1\/20 ","","28","Select","Select",""],["","10147068701","METHYLPHENIDATE HYDROCHLORIDE ER","","-30","Select","Select",""],["","16714040604","LARIN FE 1\/20 ","","28","Select","Select",""],["","11822331520","RA LORATADINE ","","30","Select","Select",""],["","60432026415","FLUTICASONE PROPIONATE","","16","Select","Select",""],["","135057602","FLONASE ALLERGY RELIEF","","10","Select","Select",""],["","45802086802","POLYETHYLENE GLYCOL 3350","","238","Select","Select",""],["","00555902658","JUNEL FE 1\/20","","28","Select","Select",""],["","16714040604","LARIN FE 1\/20","","28","Select","Select",""],["","11822331520","RA LORATADINE","","30","Select","Select",""],["","00555902658","JUNEL FE 1\/20                                                         ","TAB 43831","-28","Select","Select",""],["","10147068701","METHYLPHENIDATE HYDROCHLORIDE ER                                      ","TAB 54MG ER","-30","Select","Select",""],["","50458058701","CONCERTA                                                              ","TAB 54MG","30","Select","Select",""],["","29300013601","CLONIDINE HYDROCHLORIDE                                               ","TAB 0.2MG","30","Select","Select",""],["","16714040803","LARIN 1\/20                                                            ","TAB 43831","-21","Select","Select",""],["","11822393550","RA LAXATIVE                                                           ","POW ","238","Select","Select",""],["","00135057602","FLONASE ALLERGY RELIEF                                                ","SPR 50MCG","10","Select","Select",""],["","11822331520","RA LORATADINE                                                         ","TAB 10MG","30","Select","Select",""],["","16714040604","LARIN FE 1\/20                                                         ","TAB 43831","28","Select","Select",""],["","60432026415","FLUTICASONE PROPIONATE                                                ","SPR 50MCG","16","Select","Select",""],["","45802086802","POLYETHYLENE GLYCOL 3350                                              ","POW 3350 NF","238","Select","Select",""],["","50111056001","TRAZODONE HYDROCHLORIDE                                               ","TAB 50MG","30","Select","Select",""],["","80777027398","MODERNA COVID-19 VACCINE                                              ","INJ COVID-19","0","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","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","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":""}]}]}