{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TAHYANA   I SMITH","gend":1,"add":"12334 BEECH TRL","city":"GLOUCESTER","state":"VA","zip":"23061-9998","dob":"2002-11-21","age":"","mstatus":"","insh":"2052461*01","cliId":"","pno":"804\/413-4662","cno":"804\/413-4662","email":"","ename":"","eno":"","pphy":"SABINO-AKINS, JOYCELYN A MD","ppno":"804\/730-4690","pcpadd":"SUITE 100 7347 BELL CREEK RD","pcpcity":"MECHANICSVILLE","pcpstate":"VA","pcpzip":23111,"pcpcounty":"","pcpid":208042,"pcpname":"BON SECOURS PEDIATRICS OF MECHANICSVILLE","plan":"OHP","program":"MEDICAID","lob":"M4","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":["Z11.3","Z71.89","Z97.5","T43.222A","F33.1","N76.0","B96.89","N30.01"],"date":["2020-06-17","2020-06-17","2020-06-17","2020-05-16","2020-05-16","2020-06-06","2020-06-06","2020-04-01"],"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":[["","51293081101","PHENAZOPYRID ","200MG","6","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","14","Select","Select",""],["","58160088552","FLUARIX ","2020-21","0","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","14","Select","Select",""],["","51672200306","CLOTRIMAZOLE ","1% VAG","45","Select","Select",""],["","51293081101","PHENAZOPYRID","200MG","6","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","14","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","14","Select","Select",""],["","58160088552","FLUARIX","2020-21","0","Select","Select",""],["","51672200306","CLOTRIMAZOLE","1% VAG","45","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","",""],["N\/A","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":""}]}]}