{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JONATHAN   E BEEBE","gend":0,"add":"3709 TABLE ROCK LN","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"2003-08-27","age":"","mstatus":"","insh":"2038349*04","cliId":"","pno":"757\/383-1725","cno":"757\/383-1725","email":"","ename":"","eno":"","pphy":"LEHMAN, ROBERT D MD","ppno":"","pcpadd":"STE 101 200 GRAYSON ROAD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":100732,"pcpname":"Pediatric Affiliates of Hampton Roads","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/473-0459","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z20.828","F43.22","F32.2","R63.4","R35.8","R63.1","R63.2","Z00.01","Z13.0","Z68.52","R50.9","R09.81","G43.019","F41.8"],"date":["2021-02-16","2021-03-22","2020-02-11","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-07-21","2021-01-10","2020-03-17","2020-03-17"],"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":[["","69097083512","SERTRALINE","100MG","30","Select","Select",""],["","65162019050","NAPROXEN","500MG","30","Select","Select",""],["","00781652386","SUMATRIPTAN","20MG\/ACT","6","Select","Select",""],["","33332032001","AFLURIA","2020-21","0","Select","Select",""],["","69097083512","SERTRALINE ","TAB 100MG","30","Select","Select",""],["","00781652386","SUMATRIPTAN ","SPR 20MG\/ACT","6","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","30","Select","Select",""],["","33332032001","AFLURIA ","INJ 2020-21","0","Select","Select",""],["","19515081852","FLULAVAL ","INJ 2021-22","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","",""],["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":""}]}]}