{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MAXWELL   P ANDERTON","gend":0,"add":"2110 WAKE FOREST ST","city":"VIRGINIA BEACH","state":"VA","zip":"23451-9998","dob":"1996-04-20","age":"","mstatus":"","insh":"8979200*04","cliId":"","pno":"481-9247","cno":"481-9247","email":"","ename":"","eno":"","pphy":"DIETTER, JESSICA J DO","ppno":"757\/252-9600","pcpadd":"1800 CAMELOT DRIVE STE 200","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":117350,"pcpname":"SMG - Sentara Pediatric Physicians - Camelot","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"481-9247","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":["M54.2","R07.81","M89.8X1","R07.9","K50.90","K50.00","G89.29","Z79.899","R10.31","M79.18","U07.1","Z20.828","J45.20","M25.519","S29.012A","M62.838","R43.9","M54.6","K21.00"],"date":["2021-06-08","2021-06-02","2021-06-02","2021-06-02","2020-02-28","2021-10-08","2020-10-07","2020-10-07","2020-10-07","2021-06-02","2020-11-25","2020-11-25","2020-05-27","2021-06-02","2021-05-28","2021-05-28","2021-07-07","2021-06-08","2021-10-08"],"priorHcc":["","","","","",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":[["","00074055402","HUMIRA","40\/0.4ML","2","Select","Select",""],["","65162077810","BUDESONIDE","3MG DR","90","Select","Select",""],["","59746017306","PREDNISONE","10MG","58","Select","Select",""],["","65162074510","PROMETHAZINE","12.5MG","12","Select","Select",""],["","70010075401","METHOCARBAM","500MG","28","Select","Select",""],["","65162019010","NAPROXEN","500MG","20","Select","Select",""],["","00074055402","HUMIRA ","40\/0.4ML","-2","Select","Select",""],["","65162074510","PROMETHAZINE ","12.5MG","12","Select","Select",""],["","59746017306","PREDNISONE ","10MG","58","Select","Select",""],["","65162077810","BUDESONIDE ","3MG DR","-90","Select","Select",""],["","65162019010","NAPROXEN ","500MG","20","Select","Select",""],["","70010075401","METHOCARBAM ","500MG","28","Select","Select",""],["","00378427593","VALACYCLOVIR ","500MG","40","Select","Select",""],["","00378427593","VALACYCLOVIR","500MG","40","Select","Select",""],["","55111064501","OMEPRAZOLE","40MG","30","Select","Select",""],["","55111064501","OMEPRAZOLE ","CAP 40MG","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","",""],["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":""}]}]}