{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" KENDALL R FIELD","gend":1,"add":"8458 RADNOR RD","city":"NORFOLK","state":"VA","zip":"23503-9998","dob":"2000-03-20","age":"","mstatus":"","insh":"5200342*04","cliId":"","pno":"757\/321-0805","cno":"757\/321-0805, 623-3858","email":"","ename":"","eno":"","pphy":"SCHANK, EMILY L MD","ppno":"757\/640-0022","pcpadd":"1909 A GRANBY STREET","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23517-9998","pcpcounty":"","pcpid":571649,"pcpname":"CMG - Pediatric Associates","plan":"OHP - OPTIMA","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","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":["Z20.828","J02.9","S02.2XXA","S06.0X0A","K92.0","M48.061","M51.17","R51.9","Z03.818","J45.909","S09.90XD","R10.13","Z79.1","M51.16","M54.42","M54.16","S00.33XA","J34.2","R09.81","M54.5","S00.83XA","S02.92XA","R22.0","M95.0","J34.3","J34.89","M43.06","R20.2"],"date":["2021-05-03","2020-01-13","2021-05-10","2021-04-02","2020-04-20","2020-10-25","2020-10-25","2021-03-26","2021-05-03","2021-05-10","2021-05-04","2020-04-20","2020-04-20","2020-10-25","2020-10-25","2020-11-05","2021-03-24","2021-03-24","2021-03-24","2020-11-04","2021-03-21","2021-03-21","2021-03-21","2021-05-10","2021-05-10","2021-05-10","2020-10-01","2020-10-01"],"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":[["","59310057922","PROAIR","","17","Select","Select",""],["","00591544305","PREDNISONE","20MG","6","Select","Select",""],["","00093317431","ALBUTEROL","HFA","17","Select","Select",""],["","65862018601","CLINDAMYCIN","300MG","21","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","-12","Select","Select",""],["","64380080707","IBUPROFEN","800MG","24","Select","Select",""],["","65862016001","ZOLPIDEM","10MG","20","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","18","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","28","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":""}]}]}