{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JACKSON ORNOFF","gend":0,"add":"2209 ELIJAH ST","city":"CHESAPEAKE","state":"VA","zip":"23323-9998","dob":"2001-10-03","age":"","mstatus":"","insh":"2054535*03","cliId":"","pno":"757\/729-3282","cno":"757\/729-3282","email":"","ename":"","eno":"","pphy":"BUNTING, LISA B MD","ppno":"757\/668-2500","pcpadd":"STE 302 500 DISCOVERY DR","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":106680,"pcpname":"CMG - Children's Hospital of The King's Daughters - Chesapeake Pediatrics","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/410-5411","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/668-2540","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z00.00","Z71.3","Z13.39","Z13.31","Z23.","Z71.82","Z11.59","F90.0","F32.9","Z11.3","Z11.4","Z76.0","Z20.822"],"date":["2021-07-12","2021-07-12","2021-07-12","2021-07-12","2020-07-01","2021-07-12","2021-01-13","2021-07-12","2021-07-12","2021-07-12","2021-07-12","2021-07-12","2021-10-11"],"priorHcc":["","","","","","","","","","","","",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":[["","00093310953","AMOXICILLIN","500MG","21","Select","Select",""],["","68382004101","PROMETHAZINE","25MG","12","Select","Select",""],["","59417010110","VYVANSE","10MG","30","Select","Select",""],["","59676058015","JANSSEN","COVID-19","0","Select","Select",""],["","31722094101","HYDROCO\/APAP","5-325MG","12","Select","Select",""],["","65162046510","IBUPROFEN","600MG","40","Select","Select",""],["","72647033104","METHYLPRED","4MG","21","Select","Select",""],["","31722094101","HYDROCO\/APAP ","5-325MG","12","Select","Select",""],["","65162046510","IBUPROFEN ","600MG","40","Select","Select",""],["","72647033104","METHYLPRED ","4MG","21","Select","Select",""],["","68382004101","PROMETHAZINE ","25MG","12","Select","Select",""],["","00093310953","AMOXICILLIN ","500MG","21","Select","Select",""],["","59417010110","VYVANSE ","10MG","30","Select","Select",""],["","59676058015","JANSSEN ","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","",""],["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":""}]}]}