{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KIEARI KING","gend":1,"add":"925 41ST ST APT 11","city":"NEWPORT NEWS","state":"VA","zip":"23607-9998","dob":"2004-02-07","age":"","mstatus":"","insh":"1176301*01","cliId":"","pno":"757\/914-5486","cno":"","email":"","ename":"","eno":"","pphy":"HOEGGER, JULIE E PNP","ppno":"757\/668-2200","pcpadd":"23 MANHATTAN SQ","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":"","pcpname":"CSG - Children's Hospital of The King's Daughters - Urgent Care - Tech Ctr","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/668-2222","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","F12.10","B27.90","J02.9","R09.81","J45.50","Z20.822","E86.0","J45.30","Z91.013","J30.1","J30.89","T25.222A","T25.332A","X12.XXXA","Y93.89","Y92.038","V58.89","X12.XXXD","J45.909","Z91.19","J30.2","Z00.121","Z68.53","Z13.31","Z71.3","Z71.82","M25.562","Z23.","Z76.0","Z91.018","R10.9","R82.998","R63.4","J45.901","H92.03","Z79.899","R06.2"],"date":["2020-07-29","2020-07-29","2020-11-27","2020-11-24","2020-11-24","2020-11-24","2021-10-14","2020-11-27","2020-06-02","2020-06-02","2020-06-02","2020-06-02","2021-05-25","2021-05-28","2021-05-28","2021-05-28","2021-05-28","2021-06-02","2021-06-02","2019-06-04","2019-06-04","2019-10-09","2019-02-27","2019-02-27","2019-02-27","2019-02-27","2019-02-27","2019-06-04","2019-10-09","2019-10-09","2019-10-09","2019-05-01","2019-05-01","2019-05-01","2019-01-10","2019-01-10","2019-01-10","2019-01-10"],"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":[["","43598021040","SSD","CRE 0.01","400","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","13107005999","APAP\/CODEINE","TAB 300-30MG","15","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","59310057922","PROAIR","AER ","17","Select","Select",""],["","","BUDES\/FORMOT","AER 80-4.5","","Select","Select",""],["","49502010202","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","00186037220","SYMBICORT","AER 80-4.5","10","Select","Select",""],["","00173071720","ADVAIR","AER 230\/21","12","Select","Select",""],["","31722072690","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","90","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","17","Select","Select",""],["","08373747800","OPTICHAMBER","MIS DIAMOND","2","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":""}]}]}