{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JONITHAN LAUTERBACH","gend":0,"add":"9501 TELEGRAPH ROAD","city":"GLEN ALLEN","state":"VA","zip":"23060-9998","dob":"2003-02-04","age":"","mstatus":"","insh":"8537453*01","cliId":"","pno":"804\/240-1440","cno":"804\/240-1440","email":"","ename":"","eno":"","pphy":"SOLTYS, GRACE R MD","ppno":"804\/358-4904","pcpadd":"3602 MONUMENT AVE","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23230,"pcpcounty":"","pcpid":102482,"pcpname":"Monument Avenue Pediatrics","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"804\/627-0010","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/358-3107","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J06.9","Z04.9","D12.9","K62.0","S39.012A","Z68.54","Z20.828","H93.293","R55.","J11.1","H66.002","H73.92","H60.392","L24.7","H69.82","J30.9"],"date":["2020-05-14","2021-04-09","2020-01-14","2020-01-14","2020-03-22","2020-12-01","2020-12-02","2020-09-29","2021-04-09","2020-02-13","2020-02-13","2020-02-13","2020-09-13","2020-09-13","2020-09-29","2020-09-29"],"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":[["","68462018147","CLOTRIMAZOLE ","1%","45","Select","Select",""],["","00363023840","STOOL ","100MG","60","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","10","Select","Select",""],["","65862001501","AMOXICILLIN ","875MG","14","Select","Select",""],["","69238126601","OSELTAMIVIR ","75MG","10","Select","Select",""],["","00591505221","PREDNISONE ","5MG","21","Select","Select",""],["","52817033010","CYCLOBENZAPR ","5MG","30","Select","Select",""],["","16714079902","CETIRIZINE ","10MG","30","Select","Select",""],["","00781618667","CIPRO\/DEXA ","0.3-0.1%","8","Select","Select",""],["","61314064511","NEO\/POLY\/HC ","1% OTIC","10","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","16","Select","Select",""],["","59676058005","JANSSEN ","COVID-19","0","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","68462018147","CLOTRIMAZOLE","1%","45","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","10","Select","Select",""],["","00363023840","STOOL","100MG","60","Select","Select",""],["","69238126601","OSELTAMIVIR","75MG","10","Select","Select",""],["","65862001501","AMOXICILLIN","875MG","14","Select","Select",""],["","52817033010","CYCLOBENZAPR","5MG","30","Select","Select",""],["","00591505221","PREDNISONE","5MG","21","Select","Select",""],["","61314064511","NEO\/POLY\/HC","1% OTIC","10","Select","Select",""],["","00781618667","CIPRO\/DEXA","0.3-0.1%","8","Select","Select",""],["","60505263301","CETIRIZINE","10MG","30","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","16","Select","Select",""],["","59676058005","JANSSEN","COVID-19","0","Select","Select",""],["","69547035302","NARCAN","","2","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":""}]}]}