{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NICHOLAS   J MASTROCCO","gend":0,"add":"8429 NATHAN AVE","city":"NORFOLK","state":"VA","zip":"23518-9998","dob":"2002-04-26","age":"","mstatus":"","insh":"1384605*01","cliId":"","pno":"757\/737-5939","cno":"","email":"","ename":"","eno":"","pphy":"LEIDEL, BERNADETTE MD","ppno":"757\/668-4980","pcpadd":"6161 KEMPSVILLE CIRCLE SUITE 101","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23502,"pcpcounty":"","pcpid":"","pcpname":"CMG - Children's Hospital of The King's Daughters - PDC Pediatrics","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/668-4988","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["NO DATA","N64.52","F90.2","F41.8","F60.5","F84.0","Z00.00","Z68.1","Z13.31","Z71.3","Z71.82","R10.9","M25.461","Z11.52","U07.1","R41.840","Z23.","N62.","M70.51","D16.5","F41.9","F90.9","F42.9","L02.818","Z00.129","Z68.52","J02.9","F90.0","Z13.39","Z76.0","K09.0","K01.1"],"date":["2020-10-13","2020-10-13","2021-12-20","2021-12-20","2021-12-20","2021-12-20","2021-07-27","2021-07-27","2021-07-27","2021-07-27","2021-07-27","2020-10-21","2021-04-13","2021-10-11","2021-12-06","2021-12-06","2020-06-04","2021-05-07","2021-09-28","2019-03-27","2019-03-27","2019-03-27","2019-03-27","2019-05-12","2019-06-05","2019-06-05","2019-03-10","2019-12-26","2019-12-26","2019-12-26","2019-03-27","2019-03-27"],"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":[["","16571020106","DICLOFENAC","TAB 75MG DR","20","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","45802091987","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","59417010410","VYVANSE","CAP 40MG","30","Select","Select",""],["","13668000905","CITALOPRAM","TAB 10MG","30","Select","Select",""],["","00121048905","DIPHENHYDRAM","ELX 12.5\/5ML","100","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","21","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","20","Select","Select",""],["","00781185220","AMOX\/K","TAB 875-125","20","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","00603533815","PREDNISONE","PAK 10MG","21","Select","Select",""],["","00603233832","APAP\/CODEINE","TAB 300-30MG","12","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":""}]}]}