{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TAQUIRA   M BARTEE","gend":1,"add":"PO BOX 1191","city":"DILLWYN","state":"VA","zip":"23936-9998","dob":"1998-05-12","age":"","mstatus":"","insh":"1079821*01","cliId":"","pno":"434\/838-0802","cno":"434\/838-0802","email":"","ename":"","eno":"","pphy":"BLACKWELL, BRIAN K MD","ppno":"434\/581-3271","pcpadd":"25892 N JAMES MADISON HWY","pcpcity":"NEW CANTON","pcpstate":"VA","pcpzip":23123,"pcpcounty":"","pcpid":126591,"pcpname":"Pediatric Associates of Charlottesville North","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/581-1105","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N89.8","N91.2","B37.0","Z41.8","R10.2","Z20.828","Z20.822","S39.012A","S20.219A","E66.01","O46.90","Z3A.00","Z87.891","H10.32","Z71.3","Z71.89","S90.31XA","J98.8","J45.909","X50.0XXA","N93.8","N83.201","R10.32","Z00.00","Z23.","R11.2","M54.5","J02.9","Z30.09","B34.9","N92.0","M54.9","N93.9","N92.1","G43.809","R42.","L29.9","T78.40XA","F17.210","N91.1","Z11.1","Q07.03","R51.","S06.0X0A","G43.009","R03.0","R10.31","R10.9","R07.9"],"date":["2020-10-01","2020-10-01","2020-10-01","2020-10-01","2021-01-27","2021-06-15","2021-06-15","2021-03-21","2021-03-21","2021-03-31","2020-07-01","2020-07-01","2020-12-16","2021-05-24","2021-05-24","2021-05-24","2020-02-27","2020-04-08","2020-04-08","2020-05-14","2021-01-15","2021-01-15","2021-01-27","2021-03-26","2021-08-03","2021-03-31","2020-05-14","2020-09-27","2020-01-10","2020-02-17","2020-03-16","2020-04-08","2020-04-08","2020-06-23","2020-08-23","2020-08-23","2020-11-08","2020-11-08","2020-11-08","2020-12-16","2021-03-22","2020-07-29","2020-07-29","2020-07-29","2020-09-28","2020-09-28","2021-02-04","2021-09-04","2021-09-04"],"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":[["","66993060536","ETONOGESTERE ","ETHY EST","1","Select","Select",""],["","68462015713","ONDANSETRON ","4MG ODT","10","Select","Select",""],["","16714081901","OSELTAMIVIR ","75MG","10","Select","Select",""],["","52565012215","LIDOCAINE ","4%","15","Select","Select",""],["","68462019001","NAPROXEN ","500MG","14","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00555901467","LESSINA ","","28","Select","Select",""],["","69097084607","CYCLOBENZAPR ","10MG","10","Select","Select",""],["","00143983601","PENICILLN ","500MG","28","Select","Select",""],["","50111078810","AZITHROMYCIN ","500MG","2","Select","Select",""],["","68382013814","TOPIRAMATE ","25MG","21","Select","Select",""],["","60432053716","NYSTATIN ","100000","473","Select","Select",""],["","66890008106","","","473","Select","Select",""],["","23155065201","METRONIDAZOL ","500MG","14","Select","Select",""],["","00781261305","AMOXICILLIN ","500MG","21","Select","Select",""],["","59746017509","PREDNISONE ","20MG","15","Select","Select",""],["","00555077902","MEDROXYPR ","10MG","10","Select","Select",""],["","66993060536","ETONOGESTERE","ETHY EST","1","Select","Select",""],["","16714081901","OSELTAMIVIR","75MG","10","Select","Select",""],["","68462015713","ONDANSETRON","4MG ODT","10","Select","Select",""],["","52565012215","LIDOCAINE","4%","15","Select","Select",""],["","68462019001","NAPROXEN","500MG","14","Select","Select",""],["","00555901467","LESSINA","","28","Select","Select",""],["","00143983601","PENICILLN","500MG","28","Select","Select",""],["","69097084607","CYCLOBENZAPR","10MG","10","Select","Select",""],["","68382013814","TOPIRAMATE","25MG","21","Select","Select",""],["","60432053716","NYSTATIN","100000","473","Select","Select",""],["","68180016106","AZITHROMYCIN","500MG","2","Select","Select",""],["","23155065201","METRONIDAZOL","500MG","14","Select","Select",""],["","00781261305","AMOXICILLIN","500MG","21","Select","Select",""],["","59746017509","PREDNISONE","20MG","15","Select","Select",""],["","00555077902","MEDROXYPR","10MG","10","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","62756014202","METFORMIN ","TAB 500MG ER","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","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}