{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AHMON   R DAVIS","gend":0,"add":"15910 WARWICK BLVD APT 115","city":"NEWPORT NEWS","state":"VA","zip":"23608-9998","dob":"2002-10-25","age":"","mstatus":"","insh":"20026191*01","cliId":"","pno":"757\/236-8707","cno":"757\/236-8707","email":"","ename":"","eno":"","pphy":"AHSAN, SAIRA Z MD","ppno":"757\/253-5757","pcpadd":"SUITE 202 4374 NEW TOWN AVE","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23188,"pcpcounty":"","pcpid":129953,"pcpname":"SMG - Sentara Pediatric Physicians - New Town","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/510-9063","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F90.2","Z23.","G47.00","F50.89","R79.0","R35.0","K59.00","Z00.129","Z68.52","Z71.3","Z71.82","F84.0","R62.52","F43.20"],"date":["2020-10-30","2020-10-30","2020-10-30","2020-10-30","2020-10-30","2020-10-30","2020-10-30","2020-05-14","2020-05-14","2020-05-14","2020-05-14","2020-05-14","2020-05-14","2020-12-01"],"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":[["","00781236101","METHYPHENID ","10MG ER","30","Select","Select",""],["","50111043302","TRAZODONE ","50MG","30","Select","Select",""],["","70010001501","METHYLPHENID ","40MG ER","30","Select","Select",""],["","29300013601","CLONIDINE ","0.2MG","30","Select","Select",""],["","45802086802","POLYETH ","3350 NF","238","Select","Select",""],["","43598081115","CETIRIZINE ","10MG","30","Select","Select",""],["","68968555503","DAYTRANA ","30MG\/9HR","30","Select","Select",""],["","00781236101","METHYPHENID","10MG ER","30","Select","Select",""],["","70010001501","METHYLPHENID","40MG ER","30","Select","Select",""],["","29300013601","CLONIDINE","0.2MG","30","Select","Select",""],["","50111043302","TRAZODONE","50MG","15","Select","Select",""],["","45802086802","POLYETH","3350 NF","238","Select","Select",""],["","43598081115","CETIRIZINE","10MG","30","Select","Select",""],["","68968555503","DAYTRANA","30MG\/9HR","30","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0","Select","Select",""],["","49281042150","FLUZONE ","INJ 2021-22","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","",""],["No","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":""}]}]}