{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KEIONTAE   A DENNIS","gend":0,"add":"90 RIVER PALMS RD APT A","city":"NEWPORT NEWS","state":"VA","zip":"23608-9998","dob":"2000-09-23","age":"","mstatus":"","insh":"20026444*01","cliId":"","pno":"766-0376","cno":"766-0376","email":"","ename":"","eno":"","pphy":"WADDELL, BENJAMIN DO","ppno":"757\/595-0358","pcpadd":"321 MAIN STREET","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23601,"pcpcounty":"","pcpid":500173,"pcpname":"Childrens Clinic Ltd.","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.1","L50.5","J45.909","J31.0","L29.9","T50.905S","F90.0","F84.0","F95.2","F41.9","G47.9","L50.9","R00.0","J30.89"],"date":["2021-06-01","2020-09-17","2021-08-25","2020-09-17","2020-09-17","2020-09-17","2020-03-03","2020-03-03","2020-05-07","2020-05-07","2020-05-07","2021-08-06","2020-09-17","2020-09-17"],"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":[["","00093770198","LEVOCETIRIZI ","5MG","30","Select","Select",""],["","17772010130","TROKENDI ","25MG","30","Select","Select",""],["","45802065078","LORATADINE ","10MG","30","Select","Select",""],["","00093742698","MONTELUKAST ","10MG","30","Select","Select",""],["","45802057178","FEXOFENADINE ","180MG","90","Select","Select",""],["","50242021501","XOLAIR ","150MG\/ML","2","Select","Select",""],["","10702001250","HYDROXYZ ","50MG","30","Select","Select",""],["","49502010202","EPINEPHRINE ","0.3MG","2","Select","Select",""],["","16729020301","BUSPIRONE ","15MG","60","Select","Select",""],["","45802091987","CETIRIZINE ","10MG","120","Select","Select",""],["","17772010130","TROKENDI","25MG","30","Select","Select",""],["","00093770198","LEVOCETIRIZI","5MG","30","Select","Select",""],["","00093742698","MONTELUKAST","10MG","30","Select","Select",""],["","10702001250","HYDROXYZ","50MG","30","Select","Select",""],["","45802057178","FEXOFENADINE","180MG","90","Select","Select",""],["","45802065078","LORATADINE","10MG","90","Select","Select",""],["","50242021501","XOLAIR","150MG\/ML","2","Select","Select",""],["","49502010202","EPINEPHRINE","0.3MG","2","Select","Select",""],["","16729020301","BUSPIRONE","15MG","60","Select","Select",""],["","45802091987","CETIRIZINE","10MG","120","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":""}]}]}