{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHRISTIAN CARDOSO","gend":0,"add":"4509 OLD PRINCESS ANNE ROAD","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"2002-05-06","age":"","mstatus":"","insh":"8007810*01","cliId":"","pno":"757\/589-1524","cno":"757\/589-1524","email":"","ename":"","eno":"","pphy":"GABRIEL, NOELLE M MD","ppno":"757\/668-6500","pcpadd":"171 KEMPSVILLE ROAD BLDG B","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23502,"pcpcounty":"","pcpid":120216,"pcpname":"CMG - Tidewater Children's Associates","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"757\/355-9543","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":["F32.1","F42.2","F41.1","J02.9","Z20.828","A09.","R30.0","M54.2","Z11.3","F42.9","F43.20","S13.4XXA","M62.838","V43.62XA","Y92.488","Y93.89"],"date":["2020-10-12","2020-10-12","2020-10-12","2020-12-27","2021-05-28","2021-05-15","2021-03-29","2021-03-29","2021-03-29","2020-09-22","2021-03-22","2021-03-07","2021-03-07","2021-03-07","2021-03-07","2021-03-07"],"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":[["","69097083412","SERTRALINE ","50MG","30","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","65862001501","AMOXICILLIN ","875MG","20","Select","Select",""],["","69097083412","SERTRALINE","50MG","30","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","65862001501","AMOXICILLIN","875MG","20","Select","Select",""],["","65862022801","LAMOTRIGINE ","TAB 100MG","90","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":""}]}]}