{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMONDRE'   M CHRISTIAN-FAULK","gend":0,"add":"C\/O CYNTHIA BALLARD 5 TREAKLE TERRACE","city":"PORTSMOUTH","state":"VA","zip":"23702-9998","dob":"2005-06-06","age":"","mstatus":"","insh":"20038710*01","cliId":"","pno":"757\/673-6322","cno":"","email":"","ename":"","eno":"","pphy":"ALEGRE IPANAG, OLIVIA Y MD","ppno":"757\/673-6277","pcpadd":"SUITE 302 446 EFFINGHAM ST","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":23704,"pcpcounty":"","pcpid":"","pcpname":"PORTSMOUTH PEDIATRICS PC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/673-6411","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.81","F90.2","F84.0","F81.0","F81.81","F81.2","R07.89","F31.73","R26.89","F41.1","E78.5","F51.04","Z71.89","F31.77","Z79.899","F31.9","F31.64","E86.0","R00.0","R06.02","Z20.822","Z76.0","E55.9","J30.9","F31.89","J45.901","J06.9","R05.","J45.909","I34.0","J45.20","L70.0","L85.0","F41.9","F90.9","Z76.2","F20.9","E66.9","Z01.00","Z01.10","Z13.0","M25.569","F31.70","R94.31","R07.2","R00.2","J00.","J18.9","B34.9","R09.81","M54.9","J40."],"date":["2022-11-03","2022-11-08","2022-11-03","2022-11-03","2022-11-03","2022-11-03","2021-04-29","2021-05-18","2021-10-06","2022-11-08","2022-11-08","2022-11-08","2022-11-08","2022-11-08","2022-11-08","2021-04-25","2021-04-14","2021-04-28","2021-04-28","2021-04-28","2021-04-28","2020-06-04","2020-08-17","2021-04-21","2021-06-30","2020-01-01","2020-02-20","2020-01-01","2021-02-18","2021-04-29","2021-02-18","2020-01-09","2020-01-09","2021-04-21","2021-04-21","2021-02-18","2021-02-18","2021-02-18","2021-02-18","2021-02-18","2021-02-18","2021-02-18","2021-02-18","2021-04-29","2021-04-29","2021-04-29","2020-02-20","2020-02-20","2020-02-20","2020-02-20","2020-07-15","2020-07-12"],"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":[]},{"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":[["","29300011316","LAMOTRIGINE","TAB 150MG","60","Select","Select",""],["","80681004002","MELATONIN","TAB 5MG","60","Select","Select",""],["","11917014671","OMEGA-3","CAP 1000MG","180","Select","Select",""],["","80681002000","MULTIVITAMIN","TAB ","30","Select","Select",""],["","00228285511","GUANFACINE","TAB 4MG ER","30","Select","Select",""],["","11917014179","FISH","CAP 300MG","180","Select","Select",""],["","43068011002","FANAPT","TAB 10MG","60","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","12","Select","Select",""],["","42806055212","OMEGA-3-ACID","CAP 1GM","60","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","04351098510","AEROCHAMBER","MIS MV","2","Select","Select",""],["","50580072638","ZYRTEC","TAB 10MG","90","Select","Select",""],["","76204020060","ALBUTEROL","NEB 0.00083","180","Select","Select",""],["","06000053766","CERAVE","CRE MOISTURI","453","Select","Select",""],["","43598081115","CETIRIZINE","TAB 10MG","90","Select","Select",""],["","08373982700","OPTICHAMBER","MIS DIA LG","2","Select","Select",""],["","27434000211","NAC","CAP ","120","Select","Select",""],["","68462022401","LITHIUM","TAB 450MG ER","60","Select","Select",""],["","67877064330","MINOCYCLINE","TAB 65MG ER","30","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","30","Select","Select",""],["","50111043302","TRAZODONE","TAB 50MG","180","Select","Select",""],["","00299391716","CETAPHIL","CRE MOISTURE","453","Select","Select",""],["","71403010230","MINOLIRA","TAB 135MG","15","Select","Select",""],["","59310057922","PROAIR","AER ","17","Select","Select",""],["","00603533815","PREDNISONE","PAK 10MG","21","Select","Select",""],["","60432027516","BROM\/PSE\/DM","SYP ","120","Select","Select",""],["","45802073684","CLINDAMY\/BEN","GEL 1.2-5%","45","Select","Select",""],["","00378808245","TRETINOIN","CRE 0.00025","45","Select","Select",""],["","11917009215","FERROUS","TAB 325MG","30","Select","Select",""],["","76385012350","METHOCARBAM","TAB 500MG","40","Select","Select",""],["","58160088552","FLUARIX","INJ 2020-21","0","Select","Select",""],["","00143980305","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","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":""}]}]}