{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHELBY   F BRASFIELD","gend":1,"add":"8433 PRIMROSE ST","city":"NORFOLK","state":"VA","zip":"23503-9998","dob":"2003-05-31","age":"","mstatus":"","insh":"1592821*01","cliId":"","pno":"757\/513-6243","cno":"757\/513-6243","email":"","ename":"","eno":"","pphy":"MITCHELL, DOUGLAS MD","ppno":"757\/855-6800","pcpadd":"1529 INTERNATIONAL BLVD STE 103","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23513,"pcpcounty":"","pcpid":203871,"pcpname":"CMG - Children's Hospital of The King's Daughters - Norfolk Pediatrics","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/855-7771","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25.50","G43.019","M54.5","F32.9","F41.1","F33.1","R25.8","R42.","R26.9","R40.4","R56.9","F41.8","K59.1","J45.20","R11.2","R10.9","Z01.812","Z20.822","R10.31","G25.9","R00.2","R10.30","Z13.31","R11.11","Z30.42","R11.10","H50.00","H53.033","K52.9","G47.00","F41.9","G98.8","Z76.0","R10.33","R11.0","M25.561","F45.9","F44.5","G40.309","R19.7","Z30.013"],"date":["2020-12-15","2021-04-28","2021-04-28","2021-04-28","2021-05-12","2021-05-12","2020-11-05","2020-11-04","2020-11-04","2020-11-19","2020-11-19","2021-01-14","2021-01-12","2021-01-11","2021-01-11","2021-01-11","2021-01-11","2021-01-11","2020-12-01","2020-11-04","2020-11-04","2020-12-01","2020-12-01","2021-01-12","2021-01-14","2021-01-14","2020-01-31","2020-01-31","2020-09-04","2021-05-12","2020-12-15","2020-12-15","2020-12-15","2021-01-12","2021-01-12","2021-04-28","2020-11-05","2021-01-14","2020-11-19","2021-01-11","2020-10-22"],"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":[["","00173071820","FLOVENT ","44MCG","11","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","68462015713","ONDANSETRON ","4MG ODT","13","Select","Select",""],["","00115180401","HYDROXYZ ","50MG","60","Select","Select",""],["","68180032002","BUPROPN ","300MG XL","30","Select","Select",""],["","13107003134","MIRTAZAPINE ","15MG","30","Select","Select",""],["","59762453701","MEDROXYPR ","150MG\/ML","1","Select","Select",""],["","00904615760","VITAMIN ","2000UNIT","90","Select","Select",""],["","64764073030","TRINTELLIX ","10MG","90","Select","Select",""],["","68462010805","TOPIRAMATE ","25MG","60","Select","Select",""],["","68382050010","OMEPRAZOLE ","40MG","30","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","10702000350","PROMETHAZINE ","25MG","12","Select","Select",""],["","00591079501","DICYCLOMINE ","20MG","60","Select","Select",""],["","00173068220","VENTOLIN ","","36","Select","Select",""],["","29300013510","CLONIDINE ","0.1MG","30","Select","Select",""],["","64380080807","IBUPROFEN ","600MG","30","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","36","Select","Select",""],["","80681004002","MELATONIN ","5MG","30","Select","Select",""],["","00904645760","DOK ","100MG","90","Select","Select",""],["","00173071820","FLOVENT","44MCG","11","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00115180401","HYDROXYZ","50MG","60","Select","Select",""],["","68180032002","BUPROPN","300MG XL","30","Select","Select",""],["","13107003134","MIRTAZAPINE","15MG","30","Select","Select",""],["","59762453701","MEDROXYPR","150MG\/ML","1","Select","Select",""],["","64380080807","IBUPROFEN","600MG","30","Select","Select",""],["","10702000350","PROMETHAZINE","25MG","12","Select","Select",""],["","66993001968","ALBUTEROL","HFA","36","Select","Select",""],["","00173068220","VENTOLIN","","36","Select","Select",""],["","68382050010","OMEPRAZOLE","40MG","90","Select","Select",""],["","64764073030","TRINTELLIX","10MG","90","Select","Select",""],["","00591079501","DICYCLOMINE","20MG","180","Select","Select",""],["","80681016800","VITAMIN","25MCG","90","Select","Select",""],["","80681004002","MELATONIN","5MG","30","Select","Select",""],["","00904645760","DOK","100MG","90","Select","Select",""],["","29300013510","CLONIDINE","0.1MG","90","Select","Select",""],["","68462010805","TOPIRAMATE","25MG","60","Select","Select",""],["","57237007810","ONDANSETRON","8MG ODT","12","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","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":""}]}]}