{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JONATHAN ROBINSON","gend":0,"add":"2113 MOUNTAIN RUN DR","city":"GLEN ALLEN","state":"VA","zip":"23060-9998","dob":"2001-01-06","age":"","mstatus":"","insh":"20034176*01","cliId":"","pno":"804\/836-3446","cno":"804\/836-3446","email":"","ename":"","eno":"","pphy":"GIBSON-FRASIER, GWENDOLYN MD","ppno":"804\/747-1750","pcpadd":"STE 100 9000 INDEPENDENCE PK","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23233,"pcpcounty":"","pcpid":111487,"pcpname":"Richmond Pediatric Associates, Inc.","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"804\/551-6103","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/762-8837","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z00.00","Z23."],"date":["2020-03-06","2020-03-06"],"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":[["","00186198904","PULMICORT ","0.5MG\/2","60","Select","Select",""],["","51991029201","OXCARBAZEPIN ","150MG","60","Select","Select",""],["","00093414656","LEVALBUTEROL ","0.63MG","90","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","17","Select","Select",""],["","59310057922","PROAIR ","","17","Select","Select",""],["","80777027398","MODERNA ","COVID-19","0","Select","Select",""],["","00186198904","PULMICORT","0.5MG\/2","60","Select","Select",""],["","51991029201","OXCARBAZEPIN","150MG","60","Select","Select",""],["","00093414656","LEVALBUTEROL","0.63MG","72","Select","Select",""],["","00093317431","ALBUTEROL","HFA","17","Select","Select",""],["","59310057922","PROAIR","","17","Select","Select",""],["","80777027398","MODERNA","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","",""],["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":""}]}]}