{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RAYMOND   E SCOTT JR","gend":0,"add":"4308 CASTLE DRIVE APT C","city":"HENRICO","state":"VA","zip":"23231-9998","dob":"1985-08-11","age":"","mstatus":"","insh":"900047153*01","cliId":"8QQ5G45CJ50","pno":"804\/245-7457","cno":"804\/245-7457","email":"","ename":"","eno":"","pphy":"TOMLINSON, KARI G MD","ppno":"804\/730-4690","pcpadd":"7347 BELL CREEK RD STE 100","pcpcity":"MECHANICSVILLE","pcpstate":"VA","pcpzip":23111,"pcpcounty":"","pcpid":208042,"pcpname":"BON SECOURS PEDIATRICS OF MECHANICSVILLE","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","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":["D57.00","D57.219","R07.9","M87.852","M87.851","D57.1","J98.4","M25.552","M54.5","M87.052","R91.8","I49.9","M87.051","G47.00","K59.09","Z79.891","K59.00","F17.210","F17.290","M87.9","M87.059","M87.00","M25.551","R00.0","M87.859","J69.8","D57.01","J18.9","M25.559","I49.8","M25.512","G89.29","Z79.899","I51.7","M16.0","Z85.828","Z86.73","I42.9","I27.20","Z87.39","Z91.14","R94.31"],"date":["2021-11-14","2021-07-25","2021-10-02","2021-04-06","2021-04-06","2021-11-12","2021-05-14","2021-10-17","2021-08-21","2021-10-15","2021-08-05","2021-05-14","2021-08-14","2021-07-27","2021-06-15","2021-09-13","2021-08-07","2021-10-16","2021-07-15","2021-09-10","2021-08-14","2021-07-22","2021-09-19","2021-07-16","2021-10-15","2021-07-31","2021-08-01","2021-10-30","2021-07-22","2021-08-01","2021-08-21","2021-11-12","2021-11-12","2021-08-05","2021-09-04","2021-09-04","2021-11-12","2021-11-12","2021-11-12","2021-08-27","2021-06-18","2021-09-03"],"priorHcc":[null,"",null,"","",null,"",null,null,null,null,"","","","",null,null,null,"",null,null,"",null,"",null,"","",null,"","",null,null,null,null,null,null,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":[["","10702005701","OXYCODONE","TAB 20MG","42","Select","Select",""],["","378912398","FENTANYL","DIS 75MCG\/HR","5","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","30","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","90","Select","Select",""],["","10702005701","OXYCODONE HYDROCHLORIDE","","42","Select","Select",""],["","49483060450","IBUPROFEN ","","90","Select","Select",""],["","50111056001","TRAZODONE HYDROCHLORIDE","","30","Select","Select",""],["","49884072401","HYDROXYUREA","","-60","Select","Select",""],["","57664049983","MIRTAZAPINE","","90","Select","Select",""],["","69097052444","DICLOFENAC SODIUM","1%","100","Select","Select",""],["","00603188016","LIDOCAINE","5%","5","Select","Select",""],["","69842097417","CVS DICLOFENAC SODIIUM","1%","50","Select","Select",""],["","16571020210","DICLOFENAC SODIUM DR","50MG DR","20","Select","Select",""],["","10702005701","OXYCODONE HYDROCHLORIDE                                               ","TAB 20MG","42","Select","Select",""],["","00378912398","FENTANYL                                                              ","DIS 75MCG\/HR","5","Select","Select",""],["","49884072401","HYDROXYUREA                                                           ","CAP 500MG","60","Select","Select",""],["","57664049983","MIRTAZAPINE                                                           ","TAB 15MG","90","Select","Select",""],["","50111056001","TRAZODONE HYDROCHLORIDE                                               ","TAB 50MG","30","Select","Select",""],["","49483060450","IBUPROFEN                                                             ","TAB 800MG","90","Select","Select",""],["","69097052444","DICLOFENAC SODIUM                                                     ","GEL 0.01","100","Select","Select",""],["","00603188016","LIDOCAINE                                                             ","PAD 0.05","5","Select","Select",""],["","69842097417","CVS DICLOFENAC SODIIUM                                                ","GEL 0.01","50","Select","Select",""],["","16571020210","DICLOFENAC SODIUM DR                                                  ","TAB 50MG DR","20","Select","Select",""],["","00093031401","KETOROLAC TROMETHAMINE                                                ","TAB 10MG","30","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":""}]}]}