{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANTONIQUA   D BELSER","gend":1,"add":"1016 HUGO ST APT 412","city":"NORFOLK","state":"VA","zip":"23513-9998","dob":"1994-07-14","age":"","mstatus":"","insh":"3799646*01","cliId":"","pno":"757\/214-5329","cno":"757\/214-5329","email":"","ename":"","eno":"","pphy":"MICKUNAS, VICTOR H MD","ppno":"757\/640-0022","pcpadd":"1909 A GRANBY STREET","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23517,"pcpcounty":"","pcpid":571649,"pcpname":"CMG - Pediatric Associates","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":["O14.13","K04.01","K02.9","I10.","K08.89","F33.2","O26.892","M54.42","Z3A.16","V49.40XA","Z3A.36","Z37.0","N76.0","B96.89","Z30.09","Z32.02","R10.2","N39.0","Z32.01","Z34.03","O99.213","Z3A.30","O14.14","O72.2","O99.214","O62.0","O99.824","O72.1","E66.01","O69.89X0","Z3A.35","Z36.85","R51.9","K04.7","O26.891","Z01.89","Z3A.01","K38.8","R10.31","Z3A.13","Z20.822","Z34.02","Z3A.14","Z3A.15","O20.8","Z3A.12","H60.501","R59.0","Z3A.20","Z34.93","R89.9","K35.80","B34.9","K37.","O21.9","Z33.1","O99.89","R59.9","H92.02","O99.810","Z3A.32","Z39.1","O80.","O26.899","R10.9","Z3A.37","Z3A.39","O75.89","Z83.3","O77.0","O43.123","D49.0","Z01.812"],"date":["2020-06-23","2020-11-02","2020-11-02","2020-11-09","2020-11-02","2020-12-27","2021-03-17","2021-03-17","2021-03-17","2021-03-17","2020-06-23","2021-08-21","2020-09-01","2020-09-01","2020-09-01","2020-09-01","2020-12-20","2020-12-20","2020-12-20","2020-05-14","2020-06-22","2020-05-14","2020-06-22","2020-06-22","2021-08-19","2020-06-22","2021-08-19","2020-06-22","2020-06-22","2020-06-22","2020-06-22","2020-06-22","2020-11-09","2020-11-09","2021-02-18","2020-12-23","2020-12-23","2021-02-18","2021-02-18","2021-02-18","2021-08-19","2020-02-03","2020-01-03","2020-02-03","2021-02-18","2021-02-18","2020-03-09","2020-03-09","2020-03-09","2020-06-22","2020-06-22","2021-02-18","2020-12-29","2021-02-18","2021-02-18","2021-02-18","2020-03-09","2020-03-09","2020-03-09","2020-06-01","2020-06-01","2020-06-25","2021-08-21","2021-08-08","2021-08-08","2021-08-08","2021-08-21","2021-08-19","2021-08-19","2021-08-19","2021-08-19","2021-08-19","2021-08-19"],"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":[["","57896070310","IRON","325MG","30","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","14","Select","Select",""],["","57896070310","IRON ","325MG","30","Select","Select",""],["","00536406301","CL ","28-0.8MG","90","Select","Select",""],["","68382004101","PROMETHAZINE ","25MG","60","Select","Select",""],["","54738005001","PRENATAL ","MINERALS","30","Select","Select",""],["","24208041005","OFLOXACIN ","0.3%OTIC","10","Select","Select",""],["","16714002610","ENOXAPARIN ","60\/0.6ML","6","Select","Select",""],["","68180087613","NORETHINDRON ","0.35MG","84","Select","Select",""],["","00904645780","DOK ","100MG","60","Select","Select",""],["","00781261305","AMOXICILLIN ","500MG","21","Select","Select",""],["","00904759080","FEROSUL ","325MG","30","Select","Select",""],["","00904585652","CALCIUM ","600MG","60","Select","Select",""],["","65162046650","IBUPROFEN ","800MG","30","Select","Select",""],["","57237004101","PENICILLN ","500MG","28","Select","Select",""],["","00406048410","APAP\/CODEINE ","300-30MG","10","Select","Select",""],["","53746061701","TRAMADL\/APAP ","37.5-325","18","Select","Select",""],["","67877021905","CEPHALEXIN ","500MG","14","Select","Select",""],["","62332002231","FLUOXETINE ","10MG","7","Select","Select",""],["","68645051554","AMLODIPINE ","5MG","30","Select","Select",""],["","49035056311","","","60","Select","Select",""],["","51672127502","CLOTRIMAZOLE ","1%","30","Select","Select",""],["","49348098023","SM ","81MG EC","60","Select","Select",""],["","49035018240","EQ ","SOFTENER","30","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","14","Select","Select",""],["","00536406301","CL","28-0.8MG","90","Select","Select",""],["","68382004101","PROMETHAZINE","25MG","60","Select","Select",""],["","54738005001","PRENATAL","MINERALS","90","Select","Select",""],["","17478071310","OFLOXACIN","0.3% OP","10","Select","Select",""],["","00781261305","AMOXICILLIN","500MG","21","Select","Select",""],["","00904585652","CALCIUM","600MG","60","Select","Select",""],["","16714002610","ENOXAPARIN","60\/0.6ML","6","Select","Select",""],["","65162046650","IBUPROFEN","800MG","30","Select","Select",""],["","00378729253","NORETHINDRON","0.35MG","28","Select","Select",""],["","00904759080","FEROSUL","325MG","30","Select","Select",""],["","53746061701","TRAMADL\/APAP","37.5-325","18","Select","Select",""],["","68645051554","AMLODIPINE","5MG","30","Select","Select",""],["","00406048410","APAP\/CODEINE","300-30MG","10","Select","Select",""],["","62332002231","FLUOXETINE","10MG","7","Select","Select",""],["","51672200306","CLOTRIMAZOLE","1% VAG","30","Select","Select",""],["","49348098023","SM","81MG EC","60","Select","Select",""],["","49035018240","EQ","SOFTENER","30","Select","Select",""],["","59267100003","PFIZER","COVID-19","0","Select","Select",""],["","00904645780","DOK","100MG","60","Select","Select",""],["","57237004101","PENICILLN","500MG","28","Select","Select",""],["","67877021905","CEPHALEXIN","500MG","14","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","",""],["Yes","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":""}]}]}