{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DYNASTY STOWE","gend":1,"add":"105 GATEWAY CTS APT 305","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"2002-03-24","age":"","mstatus":"","insh":"1023593*01","cliId":"","pno":"757\/806-0018","cno":"757\/806-0018","email":"","ename":"","eno":"","pphy":"MONEYMAKER, CAROLYN S MD","ppno":"757\/668-7400","pcpadd":"601 CHILDRENS LANE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23507,"pcpcounty":"","pcpid":108662,"pcpname":"CMG - General Academic Pediatrics","plan":"OHP","program":"MEDICAID","lob":"M4","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":["F33.2","R11.2","R10.13","R10.12","Z11.3","S00.521A","N89.8","Z76.0","J45.909","A54.9","Z01.818","Z01.419","Z68.28","R10.2","R30.0","Z30.09"],"date":["2020-11-08","2020-06-19","2020-06-19","2020-06-19","2021-07-29","2021-04-30","2021-07-29","2020-08-23","2020-08-23","2020-09-18","2021-04-22","2020-09-10","2020-09-10","2021-07-29","2021-07-29","2021-07-29"],"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":[["","57237002901","AMOXICILLIN ","875MG","20","Select","Select",""],["","29300022701","METRONIDAZOL ","500MG","14","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","30","Select","Select",""],["","00054418425","DEXAMETHASON ","4MG","4","Select","Select",""],["","43598049501","NAPROXEN ","550MG","30","Select","Select",""],["","50111078810","AZITHROMYCIN ","500MG","2","Select","Select",""],["","00378427693","VALACYCLOVIR ","1GM","4","Select","Select",""],["","16714040604","LARIN ","Jan-20","84","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","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}