{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ASHANTI RIDDICK","gend":1,"add":"PO BOX 79","city":"LYNDHURST","state":"VA","zip":"22952-9998","dob":"2004-10-04","age":"","mstatus":"","insh":"1391480*01","cliId":"","pno":"540\/221-4273","cno":"302\/399-8371","email":"","ename":"","eno":"","pphy":"HOSTETTER, MELISSA MD","ppno":"540\/949-0118","pcpadd":"108 COMMUNITY DRIVE","pcpcity":"WAYNESBORO","pcpstate":"VA","pcpzip":22980,"pcpcounty":"","pcpid":"","pcpname":"VALLEY PEDIATRIC GROUP PLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/932-2059","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.60","V62.84","F12.20","Z62.811","G47.00","D50.9","E55.9","F33.3","Z11.59","F33.2","F34.81","D64.9","J30.2","F32.9","R07.9","R53.83","E61.1","J30.9","Z11.52","R05.9","J02.9","R68.83","Z20.822","L81.4","L20.84","L70.0","M54.5","F43.21","L01.01","L30.8"],"date":["2021-02-25","2021-02-26","2021-02-25","2021-02-25","2021-02-25","2021-09-13","2021-02-25","2021-03-02","2021-02-24","2021-06-09","2021-12-07","2021-02-26","2021-02-26","2021-02-26","2020-11-13","2020-11-13","2021-02-27","2021-06-07","2021-08-25","2021-10-22","2021-10-22","2021-10-22","2021-10-22","2020-01-21","2020-01-21","2020-01-21","2019-03-19","2019-01-23","2019-08-26","2019-10-21"],"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":[["","39328015705","FERROUS","SYP 300\/5ML","300","Select","Select",""],["","50428026496","CVS","TAB 8.6MG","15","Select","Select",""],["","","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","30","Select","Select",""],["","69842000003","FLUTICASONE","SPR 50MCG","10","Select","Select",""],["","68682019050","CLINDAMY\/BEN","GEL 1-5%","50","Select","Select",""],["","","FEOSOL","TAB 200MG","","Select","Select",""],["","45802041954","AMMONIUM","LOT 0.12","225","Select","Select",""],["","","VITAMIN","CAP 50000UNT","","Select","Select",""],["","00168000615","TRIAMCINOLON","OIN 0.001","15","Select","Select",""],["","65862056890","MONTELUKAST","CHW 5MG","30","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":""}]}]}