{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LINDSAY   R VENTURA CASTILLO","gend":1,"add":"512 BRIGHTWOOD AVE","city":"HAMPTON","state":"VA","zip":"23661-9998","dob":"2001-09-09","age":"","mstatus":"","insh":"7837925*01","cliId":"","pno":"757\/602-7251","cno":"757\/602-7251","email":"","ename":"","eno":"","pphy":"FUSTE, ROSA MD","ppno":"757\/875-9700","pcpadd":"1405 E KILN CREEK PKW","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23602,"pcpcounty":"","pcpid":110824,"pcpname":"Pediatric Consultants of Hampton Roads","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/875-1028","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R51.9","B35.4","J30.1","J30.2","J30.5","J30.81","J30.89","R09.82","R09.81","J34.9","H10.13","J34.2","J34.3","J35.1","B34.9","Z20.828","R19.7"],"date":["2021-02-25","2020-07-07","2020-01-30","2020-01-30","2020-01-30","2020-01-30","2020-01-30","2020-01-30","2020-01-30","2020-01-30","2020-01-30","2020-01-30","2020-01-30","2020-01-30","2020-04-16","2020-10-16","2020-03-17"],"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":[["","51672131201","MUPIROCIN ","2%","15","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","10","Select","Select",""],["","13668013701","ESCITALOPRAM ","20MG","30","Select","Select",""],["","00093742698","MONTELUKAST ","10MG","30","Select","Select",""],["","00527058610","DICYCLOMINE ","10MG","28","Select","Select",""],["","00093321992","KETOCONAZOLE ","2%","60","Select","Select",""],["","00527155201","BUT\/ASA\/CAFF ","","30","Select","Select",""],["","00093742698","MONTELUKAST","10MG","30","Select","Select",""],["","51672131201","MUPIROCIN","2%","15","Select","Select",""],["","00143312601","DICYCLOMINE","10MG","28","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","10","Select","Select",""],["","00093321930","KETOCONAZOLE","2%","60","Select","Select",""],["","00527155201","BUT\/ASA\/CAFF","","30","Select","Select",""],["","13668013701","ESCITALOPRAM","20MG","30","Select","Select",""],["","00143993905","AMOXICILLIN ","CAP 500MG","30","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":""}]}]}