{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KYRA JONES","gend":1,"add":"5708 PONCA ROAD","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"2003-09-14","age":"","mstatus":"","insh":"20040125*01","cliId":"","pno":"757\/552-0364","cno":"757\/552-0364","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":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/668-6505","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.1","Z63.79","J30.81","J30.1","J45.30","J30.89","S00.03XA","F32.2","Z91.19","U07.1","Z60.0","Z63.8"],"date":["2021-11-04","2021-09-07","2020-06-11","2021-07-29","2021-07-29","2021-07-29","2021-03-30","2020-06-01","2020-06-01","2021-04-06","2021-11-04","2021-11-04"],"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":[["","00173071520","ADVAIR ","45\/21","12","Select","Select",""],["","00093742698","MONTELUKAST ","10MG","30","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","17","Select","Select",""],["","11523432803","CLARITIN ","5MG","60","Select","Select",""],["","59310057922","PROAIR ","","17","Select","Select",""],["","00093768432","OLOPATADINE ","0.20%","2","Select","Select",""],["","65162089129","MOMETASONE ","50MCG","17","Select","Select",""],["","69842095320","ALLERGY ","5MG","60","Select","Select",""],["","45802065078","LORATADINE ","10MG","90","Select","Select",""],["","47781038426","OSELTAMIVIR ","6MG\/ML","180","Select","Select",""],["","00173072020","FLOVENT ","220MCG","12","Select","Select",""],["","47781038426","OSELTAMIVIR","6MG\/ML","180","Select","Select",""],["","11523432803","CLARITIN","5MG","60","Select","Select",""],["","00093742698","MONTELUKAST","10MG","30","Select","Select",""],["","00173071520","ADVAIR","45\/21","12","Select","Select",""],["","00093317431","ALBUTEROL","HFA","17","Select","Select",""],["","59310057922","PROAIR","","17","Select","Select",""],["","00093768432","OLOPATADINE","0.20%","2","Select","Select",""],["","65162089129","MOMETASONE","50MCG","17","Select","Select",""],["","69842095320","ALLERGY","5MG","60","Select","Select",""],["","45802065078","LORATADINE","10MG","90","Select","Select",""],["","00173072020","FLOVENT","220MCG","12","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":""}]}]}