{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMEE   Y HIDALGO","gend":1,"add":"30 OUTER DR APT 830","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"2001-10-07","age":"","mstatus":"","insh":"1738770*01","cliId":"","pno":"757\/918-3027","cno":"757\/918-3027","email":"","ename":"","eno":"","pphy":"VELAZQUEZ, NIVEA TERESA MD","ppno":"757\/668-4980","pcpadd":"6161 KEMPSVILLE CIRCLE SUITE 101","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23502,"pcpcounty":"","pcpid":130015,"pcpname":"CMG - Children's Hospital of The King's Daughters - PDC Pediatrics","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/668-4988","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L91.0","Z87.2","F12.10","F33.1","Z98.890","H69.83","N76.0","B37.3","A60.04","Z11.3","Z11.4"],"date":["2020-08-06","2020-06-30","2021-02-11","2020-03-13","2020-01-10","2020-01-10","2020-11-04","2020-11-04","2020-11-04","2020-11-04","2020-11-04"],"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":[["","00093005805","TRAMADOL ","50MG","10","Select","Select",""],["","65862044830","VALACYCLOVIR ","500MG","6","Select","Select",""],["","29300022705","METRONIDAZOL ","500MG","14","Select","Select",""],["","00065853302","CIPRODEX ","0.3-0.1%","8","Select","Select",""],["","00168020437","LIDOCAINE ","5%","35","Select","Select",""],["","50111078810","AZITHROMYCIN ","500MG","2","Select","Select",""],["","55111014512","FLUCONAZOLE ","150MG","2","Select","Select",""],["","00143924920","AMOX\/K ","875-125","20","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","00536109194","FLUTICASONE","50MCG","16","Select","Select",""],["","00093005805","TRAMADOL","50MG","10","Select","Select",""],["","65862044830","VALACYCLOVIR","500MG","6","Select","Select",""],["","29300022705","METRONIDAZOL","500MG","14","Select","Select",""],["","55111014512","FLUCONAZOLE","150MG","2","Select","Select",""],["","00168020437","LIDOCAINE","5%","35","Select","Select",""],["","50111078810","AZITHROMYCIN","500MG","2","Select","Select",""],["","00143924920","AMOX\/K","875-125","20","Select","Select",""],["","00065853302","CIPRODEX","0.3-0.1%","8","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":""}]}]}