{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NATESA   A BURTON","gend":1,"add":"7 HERBERT CT BRIDGET MCINNIS","city":"PORTSMOUTH","state":"VA","zip":"23703-9998","dob":"1999-08-27","age":"","mstatus":"","insh":"1326634*01","cliId":"","pno":"757\/679-8993","cno":"757\/679-8993","email":"","ename":"","eno":"","pphy":"MALAISAMY, ANITHA MD","ppno":"757\/488-2223","pcpadd":"SUITE 200A 4012 RAINTREE RD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23321,"pcpcounty":"","pcpid":200329,"pcpname":"Renaissance Pediatrics","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"757\/599-5927","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":["R10.84","H40.1131","Z91.14","E11.65","Z79.4","I10.","R56.9","R40.20","Z23.","E10.65","L02.91","J45.909","E11.9","Z79.899","E10.10","E87.1","NO DATA","R55.","K52.9","E66.9","Z20.822","F17.210","Z91.19","Z91.013","Z68.37","Z82.49","Z83.511","R11.2","R10.9","J45.20","Z68.35","V58.69","H40.9","R07.9","Z91.128","R93.3","R10.31","E10.9","R10.2","N83.201","N83.202","N76.0","Z83.3","M92.50","D72.829","E66.09","D64.9","E86.0","Z53.21","E10.8","Z11.3","R19.7","R05.","N30.01","E10.21","R10.10","L83.","S30.0XXA","S50.01XA","F41.0","J06.9","Z20.828","J45.21","R19.4","R07.89","R06.02","R06.82","R53.1","R10.30"],"date":["2021-05-01","2021-05-19","2020-10-22","2020-08-20","2021-06-03","2021-06-01","2020-08-21","2020-08-21","2020-10-22","2021-06-01","2020-05-15","2021-06-01","2021-06-03","2021-06-01","2021-06-02","2021-06-01","2021-06-01","2020-08-22","2020-09-17","2021-06-01","2021-06-01","2021-06-01","2021-06-01","2021-06-01","2021-06-01","2021-06-01","2021-06-01","2021-06-01","2021-04-29","2020-12-06","2021-07-08","2020-12-06","2020-12-06","2020-12-06","2020-12-06","2021-01-08","2021-01-08","2021-05-19","2021-06-24","2021-06-24","2021-06-24","2021-05-12","2020-07-04","2020-07-04","2020-07-04","2021-07-08","2020-08-23","2020-08-23","2020-11-22","2021-04-29","2021-05-12","2021-05-01","2021-05-01","2020-08-22","2020-08-22","2020-08-22","2020-01-13","2020-04-20","2020-04-20","2021-06-01","2021-07-08","2021-07-08","2021-07-08","2020-09-17","2020-12-06","2020-12-06","2020-12-06","2020-07-04","2020-08-19"],"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":[]},{"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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}