{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KENEDI HENCE","gend":1,"add":"PO BOX 2246","city":"TAPPAHANNOCK","state":"VA","zip":"22560-9998","dob":"2004-07-07","age":"","mstatus":"","insh":"1067564*01","cliId":"","pno":"804\/761-7526","cno":"","email":"","ename":"","eno":"","pphy":"LA ROSA, KATHLEEN K MD","ppno":"804\/559-0447","pcpadd":"7521 RIGHT FLANK RD STE 100","pcpcity":"MECHANICSVILLE","pcpstate":"VA","pcpzip":23116,"pcpcounty":"","pcpid":"","pcpname":"Richmond Pediatric Associates, Inc.","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/559-2037","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G35.","F43.23","R33.8","Z46.6","F32.1","H53.8","R90.82","Z97.3","H52.10","R39.11","H46.9","R20.2","R32.","E55.9","F39.","M62.81","Z83.2","H47.092","H50.9","R11.2","R51.9","Z20.828","G37.9","E23.6","R29.898","R90.89","M41.124","K59.00","R33.9","H54.61","H57.02","Z00.129","E66.3","G43.909","Z68.54"],"date":["2021-07-06","2021-02-08","2021-02-25","2021-02-25","2021-10-12","2020-12-19","2020-10-22","2020-10-20","2020-10-20","2021-02-17","2021-02-17","2021-06-03","2021-04-05","2021-06-03","2021-06-03","2020-10-19","2020-10-21","2021-08-24","2020-10-19","2020-10-21","2020-10-25","2020-10-19","2020-10-25","2020-10-20","2020-10-19","2020-10-21","2020-09-25","2020-10-25","2021-07-06","2020-12-18","2020-12-18","2019-09-10","2019-09-10","2019-11-01","2019-11-01"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","","GABAPENTIN","CAP 300MG","","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","65862001205","SERTRALINE","TAB 50MG","90","Select","Select",""],["","67877032005","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","53746010905","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","","POLYETH","POW 3350 NF","","Select","Select",""],["","","PREDNISONE","TAB 50MG","","Select","Select",""],["","","ACID","TAB 20MG","","Select","Select",""],["","","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","","OMEPRAZOLE","CAP 10MG","","Select","Select",""],["","","VITAMIN","CAP 50000UNT","","Select","Select",""],["","33342008841","RIZATRIPTAN","TAB 10MG","9","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}