{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EMILY   S MARTIN","gend":1,"add":"655 SOUTH BAY ROAD STE 2I PO BOX 7351","city":"PORTSMOUTH","state":"VA","zip":"23707-9998","dob":"2002-07-16","age":"","mstatus":"","insh":"20048230*01","cliId":"","pno":"757\/714-2982","cno":"","email":"","ename":"","eno":"","pphy":"PASQUINELLI, LAWRENCE MD","ppno":"757\/668-6500","pcpadd":"BLDG B 171 KEMPSVILLE RD","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23502,"pcpcounty":"","pcpid":"","pcpname":"CMG - Children's Hospital of The King's Daughters - Tidewater Children's Associates","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/668-6505","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G44.319","F90.0","Z55.8","F07.81","F90.2","F32.89","J45.909","F43.23","J45.998","J45.50","L20.89","J30.89","K21.9","J31.0","Z00.00","F34.1","J45.40","Z68.31","Z13.31","Z23.","Z71.3","E66.8","Z71.82","Z91.14","F39.","Z79.51","Z79.899","Z82.5","H93.293","P07.03","H35.413","F32.9","R42.","H93.13","J02.9","F43.10","H93.19","Z86.69","M25.473","M54.9","Z09.","Z00.01","B37.2","E55.9","E66.3","R21.","Z84.89"],"date":["2021-01-14","2021-01-14","2021-01-14","2021-01-14","2022-09-20","2020-01-16","2021-11-24","2020-07-28","2021-11-24","2020-07-14","2020-07-14","2020-07-14","2020-07-14","2022-02-01","2021-08-05","2022-09-20","2022-09-20","2021-08-05","2022-09-20","2022-09-20","2022-09-20","2021-08-05","2022-09-20","2021-08-05","2019-04-02","2019-04-16","2022-02-01","2022-02-01","2019-06-18","2019-10-21","2019-02-25","2019-10-21","2019-01-15","2019-01-15","2019-02-07","2019-10-23","2019-06-18","2019-06-18","2022-01-12","2022-01-12","2022-01-12","2022-09-20","2022-09-20","2022-09-20","2022-09-20","2022-09-20","2022-02-01"],"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":[["","31722072690","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","66993059802","AMPHET\/DEXTR","CAP 25MG ER","30","Select","Select",""],["","00173069600","ADVAIR","AER 250\/50","60","Select","Select",""],["","68382000105","PAROXETINE","TAB 40MG","90","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","60","Select","Select",""],["","00093321992","KETOCONAZOLE","CRE 0.02","60","Select","Select",""],["","59651000205","OMEPRAZOLE","CAP 20MG","60","Select","Select",""],["","43598081115","CETIRIZINE","TAB 10MG","90","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","","PROAIR","AER ","","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00536100901","FERROUS","TAB 325MG","30","Select","Select",""],["","00378932132","WIXELA","AER 250\/50","60","Select","Select",""],["","74312015605","D3-1000","CAP 1000UNIT","30","Select","Select",""],["","13668059502","NYSTATIN","CRE 100000","30","Select","Select",""],["","54092038901","ADDERALL","CAP 25MG","30","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","00093506105","HYDROXYZ","TAB 25MG","30","Select","Select",""],["","57237002801","AMOXICILLIN","TAB 500MG","30","Select","Select",""],["","","ONDANSETRON","TAB 4MG","","Select","Select",""],["","00085113201","PROVENTIL","AER HFA","7","Select","Select",""],["","66993058597","FLUTIC\/SALME","AER 250\/50","60","Select","Select",""],["","","TRIAMCINOLON","OIN 0.001","","Select","Select",""],["","","VYVANSE","CAP 70MG","","Select","Select",""],["","","QUETIAPINE","TAB 200MG","","Select","Select",""],["","","CLONIDINE","TAB 0.1MG","","Select","Select",""],["","00093406701","PRAZOSIN","CAP 1MG","60","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","20","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":""}]}]}