{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WILLIAM   H GRUBBS","gend":0,"add":"593 WINDSOR GATE ROAD","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"2001-11-02","age":"","mstatus":"","insh":"20059004*01","cliId":"","pno":"757\/735-3935","cno":"757\/735-3935","email":"","ename":"","eno":"","pphy":"CHILDS, MARCELLA MD","ppno":"757\/499-7442","pcpadd":"SUITE 250 4505 COLUMBUS STREET","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":102433,"pcpname":"CMG - Town Center Pediatrics","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":["H50.15","Z20.828","J18.9","J06.9","J02.9","J45.41","U07.1","H54.62","F17.200","Z88.1","Z91.013","R19.7","R10.9","R11.2","R05.1"],"date":["2021-02-05","2021-11-05","2020-11-11","2021-06-07","2021-06-07","2020-08-22","2021-08-29","2021-08-29","2021-11-05","2021-08-29","2021-08-29","2021-08-29","2021-08-29","2021-08-29","2021-11-05"],"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":[["","00173071820","FLOVENT ","44MCG","11","Select","Select",""],["","00603533932","PREDNISONE ","20MG","21","Select","Select",""],["","69238110005","DOXYCYCL ","100MG","20","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","49502010202","EPINEPHRINE ","0.3MG","2","Select","Select",""],["","57237007710","ONDANSETRON ","4MG ODT","12","Select","Select",""],["","00591079501","DICYCLOMINE ","20MG","30","Select","Select",""],["","00173071820","FLOVENT","44MCG","11","Select","Select",""],["","00603533932","PREDNISONE","20MG","21","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","49502010202","EPINEPHRINE","0.3MG","2","Select","Select",""],["","00591079501","DICYCLOMINE","20MG","30","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","12","Select","Select",""],["","69238110005","DOXYCYCL","100MG","20","Select","Select",""],["","67877057305","BENZONATATE ","CAP 100MG","15","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","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":""}]}]}