{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ELENA DIAZ","gend":1,"add":"5733 SCHOOLHOUSE RD APT 301","city":"VIRGINIA BEACH","state":"VA","zip":"23464-9998","dob":"2002-04-02","age":"","mstatus":"","insh":"1262668*01","cliId":"","pno":"757\/576-2168","cno":"757\/576-2168","email":"","ename":"","eno":"","pphy":"NORRIS, DAVID M MD","ppno":"757\/668-6700","pcpadd":"2088 PRINCESS ANNE ROAD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23456,"pcpcounty":"","pcpid":102538,"pcpname":"CMG - Children's Hospital of The King's Daughters - General Booth Pediatrics","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/668-6680","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J35.8","R10.9","R63.0","Z71.3","N93.9","D64.9","Z71.89","F90.9","Z23.","F32.9","F41.9","Z62.810","Z00.121","J03.91","Z11.59"],"date":["2020-05-28","2020-11-06","2020-11-06","2020-11-06","2020-09-03","2020-09-03","2020-09-03","2020-06-26","2020-06-26","2020-06-26","2020-06-26","2020-06-26","2020-03-20","2020-05-28","2020-05-28"],"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":[["","68180099901","FLUOXETINE ","20MG","30","Select","Select",""],["","50458058501","CONCERTA ","18MG","30","Select","Select",""],["","68180031909","BUPROPN ","150MG XL","30","Select","Select",""],["","50111043302","TRAZODONE ","50MG","15","Select","Select",""],["","00406055201","OXYCODONE ","5MG","20","Select","Select",""],["","00054418425","DEXAMETHASON ","4MG","8","Select","Select",""],["","68462072029","DROSPIRENONE ","ETHY EST","84","Select","Select",""],["","68462013281","NORETH\/ETHIN ","Jan-20","21","Select","Select",""],["","62037072501","METHYLPHENID ","18MG ER","30","Select","Select",""],["","67877024901","QUETIAPINE ","50MG","30","Select","Select",""],["","67877043003","ARIPIPRAZOLE ","2MG","30","Select","Select",""],["","00115180301","HYDROXYZ ","25MG","20","Select","Select",""],["","64380080807","IBUPROFEN ","600MG","40","Select","Select",""],["","68382050010","OMEPRAZOLE ","40MG","30","Select","Select",""],["","00904672059","ACETAMIN ","500MG","80","Select","Select",""],["","43547028910","BUPROPION ","150MG SR","30","Select","Select",""],["","68180031909","BUPROPN","150MG XL","30","Select","Select",""],["","68180099901","FLUOXETINE","20MG","30","Select","Select",""],["","50111043302","TRAZODONE","50MG","15","Select","Select",""],["","50458058501","CONCERTA","18MG","30","Select","Select",""],["","62037072501","METHYLPHENID","18MG ER","30","Select","Select",""],["","68462013281","NORETH\/ETHIN","Jan-20","21","Select","Select",""],["","68462072029","DROSPIRENONE","ETHY EST","28","Select","Select",""],["","00904672059","ACETAMIN","500MG","80","Select","Select",""],["","00406055201","OXYCODONE","5MG","20","Select","Select",""],["","00054418425","DEXAMETHASON","4MG","8","Select","Select",""],["","64380080807","IBUPROFEN","600MG","40","Select","Select",""],["","67877024901","QUETIAPINE","50MG","30","Select","Select",""],["","00115180301","HYDROXYZ","25MG","20","Select","Select",""],["","43547028910","BUPROPION","150MG SR","30","Select","Select",""],["","67877043003","ARIPIPRAZOLE","2MG","30","Select","Select",""],["","68382050010","OMEPRAZOLE","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","",""],["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":""}]}]}