{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ASHANTI   K MATTHEWS","gend":1,"add":"404 MILITARY ROAD","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"2002-12-20","age":"","mstatus":"","insh":"8418322*01","cliId":"","pno":"757\/539-5023","cno":"757\/539-5023","email":"","ename":"","eno":"","pphy":"LEVERONE, LAURA I MD","ppno":"757\/668-2250","pcpadd":"1009 HILLPOINT BLVD","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23434,"pcpcounty":"","pcpid":111145,"pcpname":"CMG - Children's Hospital of The King's Daughters - Suffolk Pediatrics","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"757\/679-8045","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/668-2255","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z30.011","N94.6","F43.23","Z23.","Z30.41","R50.9","R05.","R52.","M79.641"],"date":["2020-11-23","2020-11-23","2021-06-03","2021-01-15","2021-02-22","2020-02-20","2020-02-20","2020-02-20","2021-06-24"],"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":[["","59417010610","VYVANSE ","60MG","30","Select","Select",""],["","65862001230","SERTRALINE ","50MG","45","Select","Select",""],["","60432026415","FLUTICASONE ","50MCG","16","Select","Select",""],["","16714040604","LARIN ","Jan-20","28","Select","Select",""],["","00781635587","MOMETASONE ","50MCG","17","Select","Select",""],["","16714039102","CEFDINIR ","300MG","20","Select","Select",""],["","00085128801","NASONEX ","50MCG\/AC","17","Select","Select",""],["","65862001230","SERTRALINE","50MG","45","Select","Select",""],["","59417010610","VYVANSE","60MG","30","Select","Select",""],["","16714039102","CEFDINIR","300MG","20","Select","Select",""],["","00781635587","MOMETASONE","50MCG","17","Select","Select",""],["","60432026415","FLUTICASONE","50MCG","16","Select","Select",""],["","00085128801","NASONEX","50MCG\/AC","17","Select","Select",""],["","16714040604","LARIN","Jan-20","28","Select","Select",""],["","00378728353","NORETH\/ETHIN ","TAB FE 1\/20","28","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":""}]}]}