{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NATALIE HUMPHRIES","gend":1,"add":"322 E SHAWEN DR","city":"HAMPTON","state":"VA","zip":"23669-9998","dob":"1999-08-14","age":"","mstatus":"","insh":"1165502*01","cliId":"","pno":"757\/298-6724","cno":"","email":"","ename":"","eno":"","pphy":"SRIRAMAN, NATASHA MD","ppno":"757\/668-7331","pcpadd":"601 CHILDRENS LN","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23507,"pcpcounty":"","pcpid":"","pcpname":"CMG - Children's Hospital of The King's Daughters - General Academic Pediatrics","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/668-7537","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O32.1XX0","O60.14X0","Z3A.33","Z37.0","O71.89","Z79.899","Z39.1","Z48.02","S81.812A","F10.129","V89.2XXA","Y92.411","N94.89","V23.89","R11.0","NO DATA","S01.21XA","N91.2","S81.012A","Z23.","O26.842","Z3A.28","Z34.83","J06.9","Z20.828","R05.","R07.0","R53.83","Z38.00","P07.17","P07.36","P92.2","Q82.6","Z32.01","N76.2","J20.9","J02.9","R07.9","O36.5930","Z3A.34","Z3A.36","F41.1","F40.11","F33.41","Z3A.32","T74.21XA","Z13.9","L70.0","Z3A.31","Z34.93","O45.93","O99.344","F32.9","F41.9","O32.6XX0","O70.0","O99.820","Z34.01","Z3A.09","Z36.89","Z11.3","Z36.4","O36.5990","O60.10X0"],"date":["2020-11-18","2020-11-18","2020-11-18","2020-11-18","2020-11-18","2020-11-18","2020-12-27","2021-03-20","2021-06-29","2021-06-29","2021-06-29","2021-06-29","2021-11-11","2021-11-11","2021-11-11","2021-11-11","2021-03-14","2020-05-01","2021-06-29","2020-10-08","2020-10-08","2020-10-08","2020-10-08","2020-10-30","2020-10-30","2020-10-30","2020-10-30","2020-10-30","2020-12-02","2020-12-02","2020-12-02","2020-12-02","2020-12-02","2019-03-28","2019-04-03","2019-06-05","2019-06-08","2019-06-05","2019-10-19","2019-10-04","2019-10-19","2019-02-12","2019-02-12","2019-02-12","2019-09-19","2019-01-20","2019-01-20","2019-06-24","2019-09-10","2019-09-19","2019-10-19","2019-10-19","2019-10-19","2019-10-19","2019-10-19","2019-10-19","2019-10-19","2019-03-28","2019-03-28","2019-03-28","2019-03-28","2019-10-17","2019-10-19","2019-10-19"],"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":[["","64011030103","MAKENA","INJ 275MG","4","Select","Select",""],["","10702000201","PROMETHAZINE","TAB 12.5MG","30","Select","Select",""],["","65162046650","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","65862001330","SERTRALINE","TAB 100MG","30","Select","Select",""],["","","LARIN","TAB 43831","","Select","Select",""],["","00113088210","SIMETHICONE","DRO 20\/0.3ML","30","Select","Select",""],["","50383091750","VITAMIN","DRO 400UNIT","50","Select","Select",""],["","","BONJESTA","TAB 20-20MG","","Select","Select",""],["","","DOXYL\/PYRID","TAB 10-10MG","","Select","Select",""],["","00093005401","BUSPIRONE","TAB 10MG","60","Select","Select",""],["","68025005930","OB","CAP PETITE","30","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","00904645780","DOK","CAP 100MG","30","Select","Select",""],["","00591354125","BUPROPION","TAB 150MG SR","30","Select","Select",""],["","57896070310","IRON","TAB 325MG","30","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","51672130406","TERCONAZOLE","CRE 0.004","45","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","15","Select","Select",""],["","00087040203","POLY-VI-SOL","DRO ","50","Select","Select",""],["","00087086644","D-VI-SOL","LIQ 400UNIT","50","Select","Select",""],["","00904759160","FERROUS","TAB 325MG","30","Select","Select",""],["","00904531360","PRENATAL","TAB 27-0.8MG","30","Select","Select",""],["","00378334053","XULANE","DIS 150-35","3","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":""}]}]}