{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHELBY   N SWITZER","gend":1,"add":"905 ASHWAY CT","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"2001-10-20","age":"","mstatus":"","insh":"1483639*01","cliId":"","pno":"757\/373-0912","cno":"757\/373-0912","email":"","ename":"","eno":"","pphy":"LIVINGOOD, JENNIFER MD","ppno":"757\/640-0022","pcpadd":"1909 A GRANBY STREET","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23517,"pcpcounty":"","pcpid":571649,"pcpname":"CMG - Pediatric Associates","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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B07.0","Z20.828","R51.9","NO DATA","Z11.1","F43.23","G43.109","J20.9","R07.9","G43.009","Z00.00","Z71.3","Z13.31","Z71.82","K29.70","M62.838","L03.032","J02.9","G43.909","Z30.46"],"date":["2020-05-05","2021-07-25","2020-10-18","2020-10-18","2021-06-09","2020-11-05","2021-06-21","2021-07-25","2020-01-21","2021-02-15","2020-07-20","2020-07-20","2020-07-20","2020-07-20","2020-07-20","2020-10-02","2021-07-12","2021-07-18","2021-06-07","2021-09-10"],"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":[["","16571020110","DICLOFENAC ","75MG DR","20","Select","Select",""],["","11822527950","ACID ","20MG","28","Select","Select",""],["","55111015834","OMEPRAZOLE ","20MG","14","Select","Select",""],["","00378632001","VERAPAMIL ","120MG ER","30","Select","Select",""],["","65862052201","NAPROXEN ","500MG","60","Select","Select",""],["","55111029109","SUMATRIPTAN ","25MG","9","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","68382013805","TOPIRAMATE ","25MG","30","Select","Select",""],["","67877021560","CEFUROXIME ","250MG","20","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","30","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","20","Select","Select",""],["","08373747800","OPTICHAMBER ","DIAMOND","1","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","16571020110","DICLOFENAC","75MG DR","20","Select","Select",""],["","11822527950","ACID","20MG","28","Select","Select",""],["","00781286810","OMEPRAZOLE","20MG DR","37","Select","Select",""],["","65862052201","NAPROXEN","500MG","60","Select","Select",""],["","00378632001","VERAPAMIL","120MG ER","30","Select","Select",""],["","00527185943","SUMATRIPTAN","20MG\/ACT","6","Select","Select",""],["","67877032105","IBUPROFEN","800MG","30","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","68382013805","TOPIRAMATE","25MG","30","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","67877021560","CEFUROXIME","250MG","20","Select","Select",""],["","08373747800","OPTICHAMBER","DIAMOND","1","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","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":""}]}]}