{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"COLLIN STONE","gend":0,"add":"2220 BAYBERRY ST UNIT A","city":"VIRGINIA BEACH","state":"VA","zip":"23451-9998","dob":"2003-05-28","age":"","mstatus":"","insh":"1972777*01","cliId":"","pno":"757\/517-5018","cno":"757\/517-5018","email":"","ename":"","eno":"","pphy":"CRANDLEY, KATE MD","ppno":"757\/668-6500","pcpadd":"BLDG B 171 KEMPSVILLE RD","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23502,"pcpcounty":"","pcpid":120216,"pcpname":"CMG - Children's Hospital of The King's Daughters - Tidewater Children's Associates","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/668-6505","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L25.9"],"date":["2020-10-12"],"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":[["","65862057490","MONTELUKAST ","10MG","30","Select","Select",""],["","62332002231","FLUOXETINE ","10MG","90","Select","Select",""],["","29300013505","CLONIDINE ","0.1MG","60","Select","Select",""],["","59310057922","PROAIR ","","17","Select","Select",""],["","51660093901","CETIRIZINE ","10MG","30","Select","Select",""],["","68791010104","DERMA-SMOOTH ","\/FS BODY","118","Select","Select",""],["","45802005535","TRIAMCINOLON ","0.10%","30","Select","Select",""],["","00168014630","HYDROCORT ","2.50%","28","Select","Select",""],["","65162070486","FLUOCIN ","BODY","118","Select","Select",""],["","45802039000","TACROLIMUS ","0.03%","60","Select","Select",""],["","59310057922","PROAIR","","17","Select","Select",""],["","29300013505","CLONIDINE","0.1MG","60","Select","Select",""],["","62332002231","FLUOXETINE","10MG","90","Select","Select",""],["","51660093901","CETIRIZINE","10MG","30","Select","Select",""],["","00168014630","HYDROCORT","2.50%","28","Select","Select",""],["","45802039000","TACROLIMUS","0.03%","60","Select","Select",""],["","68791010104","DERMA-SMOOTH","\/FS BODY","118","Select","Select",""],["","65162070486","FLUOCIN","BODY","118","Select","Select",""],["","65862057490","MONTELUKAST","10MG","30","Select","Select",""],["","45802005535","TRIAMCINOLON","0.10%","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":""}]}]}