{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PAUL   F SOUTHERN","gend":0,"add":"2917 GAINES LNDG","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"2001-03-27","age":"","mstatus":"","insh":"1477003*04","cliId":"","pno":"757\/412-2260","cno":"757\/412-2260","email":"","ename":"","eno":"","pphy":"MICKUNAS, VICTOR H MD","ppno":"757\/640-0022","pcpadd":"1909 A GRANBY STREET","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23517,"pcpcounty":"","pcpid":571649,"pcpname":"CMG - Children's Hospital of The King's Daughters - Pediatric Associates","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/437-2882","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/640-0808","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J35.2","J35.03","R59.0","L82.1","Z71.9","Z00.00","R62.50","M54.2","J03.01","Z20.828","J30.9","Z79.899","R69.","J35.02","R19.7","Z00.01","J02.0","Z71.3","Z13.31","Z71.82","R62.52","B07.9","B07.8","B34.9"],"date":["2020-05-20","2020-05-20","2020-05-20","2021-01-20","2021-06-07","2020-03-23","2020-03-23","2020-03-25","2020-05-06","2020-05-18","2020-05-20","2020-05-20","2020-01-15","2020-05-20","2020-08-14","2020-03-20","2020-03-20","2020-03-20","2020-03-20","2020-03-20","2020-03-20","2021-01-20","2021-06-07","2020-05-06"],"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":[["","69238126601","OSELTAMIVIR","75MG","10","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","62332042631","BENZONATATE","100MG","21","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","65862064163","AZITHROMYCIN","250MG","6","Select","Select",""],["","00527193006","CLARITHROMYC","500MG ER","-42","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","42","Select","Select",""],["","0","","","500","Select","Select",""],["","65862018601","CLINDAMYCIN","300MG","40","Select","Select",""],["","16714049401","AMOX\/K","500-125","21","Select","Select",""],["","59676058015","JANSSEN","COVID-19","0","Select","Select",""],["","65862064163","AZITHROMYCIN ","250MG","6","Select","Select",""],["","69238126601","OSELTAMIVIR ","75MG","10","Select","Select",""],["","62332042631","BENZONATATE ","100MG","21","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","16714049401","AMOX\/K ","500-125","42","Select","Select",""],["","00527193006","CLARITHROMYC ","500MG ER","42","Select","Select",""],["","65862018601","CLINDAMYCIN ","300MG","40","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","42","Select","Select",""],["","59676058015","JANSSEN ","COVID-19","0","Select","Select",""],["","00781618667","CIPRO\/DEXA","0.3-0.1%","-8","Select","Select",""],["","00781618667","CIPRO\/DEXA ","SUS 0.3-0.1%","-8","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","",""],["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":""}]}]}