{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALVEETA EARL","gend":1,"add":"5520 GATES LANDING RD APT 1","city":"VIRGINIA BEACH","state":"VA","zip":"23464-9998","dob":"2002-08-10","age":"","mstatus":"","insh":"20063129*01","cliId":"","pno":"757\/256-4659","cno":"","email":"","ename":"","eno":"","pphy":"ASKINS, CRYSTAL N NP","ppno":"757\/488-2223","pcpadd":"STE 200A 4012 RAINTREE RD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23321,"pcpcounty":"","pcpid":"","pcpname":"Renaissance Pediatrics","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/488-8398","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.419","Z68.42","N92.0","N94.4","F31.12","F31.32","F43.10","F12.20","Z13.0","Z11.3","K63.5","R10.33","R11.0","K59.00","R19.7","E66.9","R70.0","R19.5","Z01.812","Z20.822","Z13.31","R10.13","K59.04","K21.9","J06.9","F17.210","Z20.828","B97.89","R51.9","Z11.4","K12.0","R10.9","S62.341A","Z72.51","Z30.40","Z30.09","M79.603","S69.90XA","N92.1","Z30.011","M62.89","D50.0","R79.1","R10.31","R10.32","R07.89","Z88.9","R20.2","D64.9","NO DATA","F41.9","Z83.3","Z82.49","Z79.899","N30.01","F12.90","R10.84","N76.0","N89.8","J10.1","Z30.431","Z30.430","Z32.02","R21.","W57.XXXA","D50.8","R19.8","Z86.19","R89.5","L21.8","L73.8","R14.0","Z30.9"],"date":["2021-07-19","2020-08-14","2020-08-14","2020-08-14","2020-11-19","2022-04-10","2021-06-10","2021-06-10","2021-07-19","2022-07-15","2021-02-16","2022-01-27","2021-02-16","2022-01-24","2021-02-16","2022-03-01","2022-06-09","2021-02-16","2021-02-16","2021-11-29","2021-05-12","2022-01-27","2022-10-19","2022-10-19","2021-11-29","2021-08-26","2022-06-14","2021-11-29","2021-11-29","2021-01-03","2021-01-03","2021-02-16","2021-04-27","2021-10-04","2021-10-04","2021-10-04","2021-03-18","2021-03-18","2022-01-24","2020-08-25","2020-11-09","2022-01-24","2021-02-24","2021-02-03","2021-02-03","2021-11-29","2020-06-24","2022-09-19","2022-09-11","2022-09-11","2022-09-11","2022-09-11","2022-09-11","2022-09-11","2022-09-14","2022-09-14","2022-09-14","2022-01-14","2022-09-19","2022-06-14","2022-09-19","2022-06-01","2022-06-01","2022-03-29","2022-03-29","2022-10-19","2022-10-19","2022-05-04","2022-05-04","2022-03-01","2022-03-01","2022-06-09","2022-03-22"],"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":[["","00904539561","FERREX","CAP 150MG","30","Select","Select",""],["","00378668910","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","51672135708","FLUOCIN","OIL 0.01% SC","118","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","31722063231","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","68180016011","AZITHROMYCIN","TAB 250MG","4","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","56","Select","Select",""],["","00406012310","HYDROCO\/APAP","TAB 5-325MG","8","Select","Select",""],["","68001036503","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","45802046564","KETOCONAZOLE","SHA 0.02","120","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","68001025320","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","","IBUPROFEN","TAB 800MG","","Select","Select",""],["","45802091987","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","24658031205","DOXYCYCL","TAB 100MG","14","Select","Select",""],["","67877021560","CEFUROXIME","TAB 250MG","20","Select","Select",""],["","59779081710","CVS","SPR 0.0005","30","Select","Select",""],["","64980032005","TRIAMCINOLON","PST DEN 0.1%","5","Select","Select",""],["","49483034150","ACETAMINOPHN","TAB 500MG","40","Select","Select",""],["","64380071207","BENZONATATE","CAP 100MG","20","Select","Select",""],["","68001039708","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","00781196260","CLARITHROMYC","TAB 500MG","28","Select","Select",""],["","63044020301","IFEREX","CAP ","30","Select","Select",""],["","00527128210","DICYCLOMINE","TAB 20MG","90","Select","Select",""],["","68462039610","OMEPRAZOLE","CAP 20MG","90","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","12","Select","Select",""],["","","ARIPIPRAZOLE","TAB 15MG","","Select","Select",""],["","","HYDROXYZ","TAB 50MG","","Select","Select",""],["","","HYDROCORT","OIN 0.025","","Select","Select",""],["","","METHOCARBAM","TAB 500MG","","Select","Select",""],["","","HEATHER","TAB 0.35MG","","Select","Select",""],["","","DICLOFENAC","TAB 50MG DR","","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":""}]}]}