{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KHYREE   K SYDNOR","gend":0,"add":"1104 CROSSROADS TRL","city":"NATHALIE","state":"VA","zip":"24577-9998","dob":"2000-12-15","age":"","mstatus":"","insh":"20035872*01","cliId":"","pno":"434\/421-2241","cno":"434\/446-5863","email":"","ename":"","eno":"","pphy":"EBALO, NONNA L MD","ppno":"434\/572-3635","pcpadd":"2202 BEECHMONT ROAD","pcpcity":"SOUTH BOSTON","pcpstate":"VA","pcpzip":24592,"pcpcounty":"","pcpid":"","pcpname":"SOUTH BOSTON PEDIATRICS","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"000\/000-0000","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E43.","T80.212A","Z48.815","K55.9","Z43.1","K65.0","R10.9","A09.","E86.0","N17.9","NO DATA","R18.8","Z46.82","K65.1","Z45.2","K56.7","J18.9","G89.18","D72.829","Z93.1","E44.1","K56.2","K31.89","K55.8","A41.9","J95.821","N17.0","J98.11","Z68.1","D64.89","R32.","K55.029","Z87.820","Z90.49","T14.90XS","J96.00","N19.","J96.01","R00.0","T81.32XA","R10.10","Z99.81","D62.","E46.","E44.0","R13.10","R62.7","N28.9","D64.9"],"date":["2019-04-08","2019-03-11","2019-03-29","2019-04-08","2019-05-07","2019-02-21","2019-02-21","2019-02-21","2019-02-21","2019-02-25","2019-02-24","2019-03-11","2019-03-11","2019-03-11","2019-02-24","2019-03-02","2019-03-02","2019-03-02","2019-03-02","2019-05-07","2019-03-12","2019-02-21","2019-02-22","2019-02-22","2019-02-24","2019-02-22","2019-02-22","2019-02-24","2019-02-22","2019-02-22","2019-02-22","2019-02-21","2019-02-21","2019-02-21","2019-02-21","2019-02-25","2019-02-22","2019-02-24","2019-02-27","2019-02-22","2019-02-22","2019-02-22","2019-02-25","2019-02-25","2019-02-26","2019-03-18","2019-03-18","2019-02-21","2019-02-23"],"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":[["","80777027315","MODERNA","INJ COVID-19","0","Select","Select",""],["","00536344238","CEROVITE","TAB ADVANCED","30","Select","Select",""],["","00603020922","MAG","TAB 400MG","120","Select","Select",""],["","00904671980","ACETAMINOPHE","TAB 325MG","30","Select","Select",""],["","00093220401","METOCLOPRAM","TAB 5MG","30","Select","Select",""],["","94688001476","PROSOURCE","LIQ NO CARB","900","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":""}]}]}