{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JESSICA   R BOBENHAUSEN","gend":1,"add":"826 E 28TH ST APT 4","city":"NORFOLK","state":"VA","zip":"23504-9998","dob":"2003-04-27","age":"","mstatus":"","insh":"8679088*01","cliId":"","pno":"757\/705-6050","cno":"757\/705-6050","email":"","ename":"","eno":"","pphy":"MONEYMAKER, CAROLYN S MD","ppno":"757\/668-7400","pcpadd":"601 CHILDRENS LANE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23507,"pcpcounty":"","pcpid":108662,"pcpname":"CMG - General Academic Pediatrics","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/668-9810","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S93.402A","R50.9","J10.1","NO DATA","N89.8","Z71.1","J03.90","Z01.419","N92.6","N94.6","Z68.43","J02.9","R07.89","R51.9","H53.149","A53.9","F19.10"],"date":["2020-10-23","2020-03-01","2020-03-01","2020-03-01","2020-01-06","2020-06-04","2020-05-06","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2020-06-04","2021-07-09","2021-07-09","2021-07-08","2021-07-09","2021-07-09"],"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":[["","65862018601","CLINDAMYCIN ","300MG","28","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","473","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","20","Select","Select",""],["","31722063231","OSELTAMIVIR ","75MG","10","Select","Select",""],["","00143314250","DOXYCYCL ","100MG","20","Select","Select",""],["","00406051205","OXYCOD\/APAP ","5-325MG","12","Select","Select",""],["","00781261305","AMOXICILLIN ","500MG","30","Select","Select",""],["","65162019011","NAPROXEN ","500MG","20","Select","Select",""],["","59746017509","PREDNISONE ","20MG","21","Select","Select",""],["","65862018601","CLINDAMYCIN","300MG","28","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","00406051205","OXYCOD\/APAP","5-325MG","12","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","64380080707","IBUPROFEN","800MG","20","Select","Select",""],["","16714081901","OSELTAMIVIR","75MG","10","Select","Select",""],["","00781261305","AMOXICILLIN","500MG","30","Select","Select",""],["","59746017509","PREDNISONE","20MG","21","Select","Select",""],["","00143314250","DOXYCYCL","100MG","20","Select","Select",""],["","65162019011","NAPROXEN","500MG","20","Select","Select",""],["","50474015049","TUSSIONEX ","SUS 10-8\/5ML","50","Select","Select",""],["","59310057922","PROAIR ","AER ","17","Select","Select",""],["","62542030117","HYD ","SUS 10-8\/5ML","50","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","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":""}]}]}