{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALICIA   V TAYLOR","gend":1,"add":"924 BALTIMORE ST","city":"NORFOLK","state":"VA","zip":"23505-9998","dob":"2004-05-28","age":"","mstatus":"","insh":"1360834*01","cliId":"","pno":"757\/513-7383","cno":"757\/893-0520","email":"","ename":"","eno":"","pphy":"NASH, MARGARET R MD","ppno":"757\/451-5000","pcpadd":"7423 GRANBY STREET","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23505,"pcpcounty":"","pcpid":"","pcpname":"WARDS CORNER PEDIATRICS","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/451-5005","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N76.0","Z30.40","R63.4","Z30.41","L44.4","Z00.129","J30.2","Z13.0","Z23.","Z13.31","B37.3","Z30.09","L20.9","R22.43","F51.02","F06.4","R53.83","R60.0","M25.562","F41.1","Z13.89","Z00.121","F41.9"],"date":["2021-01-08","2021-08-13","2021-11-17","2021-11-17","2020-04-08","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-07-14","2021-07-14","2021-07-14","2021-10-26","2020-04-10","2020-04-10","2020-03-16","2021-07-22","2021-07-22","2019-09-30","2019-09-30","2019-07-24","2019-07-24"],"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":[["","","LORATADINE","TAB 10MG","","Select","Select",""],["","59267100003","PFIZER","INJ COVID-19","0","Select","Select",""],["","68462011944","FLUCONAZOLE","TAB 150MG","3","Select","Select",""],["","71671010003","TWIRLA","DIS 120-30","3","Select","Select",""],["","60432026415","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00378728353","NORETH\/ETHIN","TAB FE 1\/20","84","Select","Select",""],["","57237002801","AMOXICILLIN","TAB 500MG","21","Select","Select",""],["","65162046650","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","72647033104","METHYLPRED","TAB 4MG","21","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","29300022701","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","68462029817","CLOTRIM\/BETA","CRE DIPROP","45","Select","Select",""],["","","HYDROXYZ","TAB 25MG","","Select","Select",""],["","","HYDROCORT","CRE 0.01","","Select","Select",""],["","","ALLERGY","TAB 10MG","","Select","Select",""],["","00093300993","LANSOPRAZOLE","TAB 30MG","30","Select","Select",""],["","65862001130","SERTRALINE","TAB 25MG","60","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":""}]}]}