{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JYSIAH   D WILSON","gend":1,"add":"1000 LITTON LN APT 1F","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"2002-06-27","age":"","mstatus":"","insh":"8062943*01","cliId":"","pno":"757\/809-3771","cno":"757\/809-3771","email":"","ename":"","eno":"","pphy":"BROOKS, KATHRYN F MD","ppno":"757\/668-2600","pcpadd":"GODWIN BLDG ON RT 10 1005 COM LN ST","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23434,"pcpcounty":"","pcpid":152665,"pcpname":"CMG - Children's Hospital of The King's Daughters - Nansemond Pediatrics","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/668-2620","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K51.00","N64.4","Z30.9","Z23.","S05.01XA","H10.33","NO DATA","V87.7XXA","Z30.42","K59.1","Z13.31","K52.9","Z20.828","U07.1","Z32.02","M54.9","Z00.129","Z68.52","Z13.39","Z71.3","Z71.82","S60.10XA","N76.0","R22.0","R21.","Z00.01","L85.3","R45.89"],"date":["2020-01-28","2020-07-09","2020-01-28","2020-05-01","2021-05-16","2021-05-16","2021-05-16","2021-05-16","2020-02-10","2020-02-11","2021-11-01","2020-02-11","2020-11-16","2021-03-06","2021-03-06","2020-11-06","2020-03-24","2020-03-24","2021-11-01","2020-03-24","2020-03-24","2021-07-31","2021-09-29","2021-10-04","2021-10-04","2021-11-01","2021-11-01","2021-11-01"],"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":[["","59762453802","MEDROXYPR ","150MG\/ML","1","Select","Select",""],["","68462015713","ONDANSETRON ","4MG ODT","20","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","18","Select","Select",""],["","66685100100","AMOX\/K ","875-125","20","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","57237000511","FLUCONAZOLE ","150MG","1","Select","Select",""],["","00378427577","VALACYCLOVIR ","500MG","40","Select","Select",""],["","51672130406","TERCONAZOLE ","0.40%","45","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","14","Select","Select",""],["","59762453802","MEDROXYPR","150MG\/ML","1","Select","Select",""],["","68462015713","ONDANSETRON","4MG ODT","20","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","18","Select","Select",""],["","66685100100","AMOX\/K","875-125","20","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","51672130406","TERCONAZOLE","0.40%","45","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","1","Select","Select",""],["","00378427577","VALACYCLOVIR","500MG","40","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","14","Select","Select",""],["","23155050105","HYDROXYZ","25MG","30","Select","Select",""],["","23155050105","HYDROXYZ ","TAB 25MG","30","Select","Select",""],["","45802005535","TRIAMCINOLON ","OIN 0.001","60","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0","Select","Select",""],["","42799020801","TINIDAZOLE ","TAB 500MG","4","Select","Select",""],["","70461032103","FLUCLVX ","INJ 2021-22","0","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":""}]}]}