{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TAIYONNA   M KNOX","gend":1,"add":"5776 ACCOMAC SQ APT 202","city":"CHESAPEAKE","state":"VA","zip":23320,"dob":"2003-09-05","age":"","mstatus":"","insh":"8871817*01","cliId":"","pno":"757\/450-4858","cno":"757\/450-4858","email":"","ename":"","eno":"","pphy":"MINK, JAMES W MD","ppno":"757\/668-2650","pcpadd":"SUITE A 601 INNOVATION DRIVE","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":120216,"pcpname":"CMG - Tidewater Children's Associates","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/668-2655","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F32.9","F41.1","R07.9","R05.","B37.0","J45.909","Z20.828","F39.","V62.84","D50.9","E55.9","F41.9","R07.89","R42.","R20.2","H10.45","G43.909","R53.81","J45.21","J02.9","M25.562","F33.9","D64.9","J45.20","G43.009","E66.8","Z68.54","Z11.3","Z09.","F33.0","F32.2"],"date":["2020-11-04","2021-08-25","2020-02-18","2020-07-08","2020-07-17","2021-08-26","2020-07-08","2020-04-03","2021-08-26","2020-04-03","2020-04-03","2020-06-11","2020-02-18","2021-05-10","2020-02-18","2020-04-16","2020-06-11","2020-03-02","2020-03-02","2021-05-10","2021-05-10","2020-03-30","2020-03-30","2020-03-30","2021-05-14","2021-05-14","2021-05-14","2021-05-14","2020-07-17","2021-08-25","2021-08-26"],"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":[["","65862001205","SERTRALINE ","50MG","30","Select","Select",""],["","08373747800","OPTICHAMBER ","DIAMOND","2","Select","Select",""],["","04351079810","AEROCHAMBER ","PLUS","2","Select","Select",""],["","00904759080","FEROSUL ","325MG","30","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","4","Select","Select",""],["","00093506105","HYDROXYZ ","25MG","60","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","17","Select","Select",""],["","00173071920","FLOVENT ","110MCG","12","Select","Select",""],["","70710122600","AMITRIPTYLIN ","25MG","30","Select","Select",""],["","60505057501","OLOPATADINE ","0.10%","5","Select","Select",""],["","62756052069","SUMATRIPTAN ","25MG","18","Select","Select",""],["","68382013805","TOPIRAMATE ","25MG","360","Select","Select",""],["","60258015001","SF ","1.10%","51","Select","Select",""],["","00054414622","CLOTRIMAZOLE ","10MG","35","Select","Select",""],["","57237000511","FLUCONAZOLE ","150MG","1","Select","Select",""],["","00363014082","ALL ","220MG","40","Select","Select",""],["","42806016001","HYDROXYZ","25MG","30","Select","Select",""],["","69452015120","VITAMIN","50000UNT","4","Select","Select",""],["","00904759080","FEROSUL","325MG","30","Select","Select",""],["","00093317431","ALBUTEROL","HFA","17","Select","Select",""],["","70710122600","AMITRIPTYLIN","25MG","30","Select","Select",""],["","65862001205","SERTRALINE","50MG","30","Select","Select",""],["","08373747800","OPTICHAMBER","DIAMOND","2","Select","Select",""],["","04351079810","AEROCHAMBER","PLUS","2","Select","Select",""],["","68382013805","TOPIRAMATE","25MG","360","Select","Select",""],["","00054414622","CLOTRIMAZOLE","10MG","35","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","1","Select","Select",""],["","60258015001","SF","1.10%","51","Select","Select",""],["","00173071920","FLOVENT","110MCG","12","Select","Select",""],["","00363014082","ALL","220MG","40","Select","Select",""],["","62756052069","SUMATRIPTAN","25MG","18","Select","Select",""],["","00555901858","TRI-SPRINTEC","","84","Select","Select",""],["","50111064801","FLUOXETINE","20MG","60","Select","Select",""],["","60505057501","OLOPATADINE","0.10%","5","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":""}]}]}