{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHILO SMITH","gend":1,"add":"5770 ARTEMUS ROAD","city":"GAINESVILLE","state":"VA","zip":"20155-9998","dob":"2003-10-19","age":"","mstatus":"","insh":"2112231*01","cliId":"","pno":"703\/754-1411","cno":"","email":"","ename":"","eno":"","pphy":"GIANCOLA, FRANK MD","ppno":"703\/330-3939","pcpadd":"SUITE 306 8640 SUDLEY ROAD","pcpcity":"MANASSAS","pcpstate":"VA","pcpzip":20110,"pcpcounty":"","pcpid":"","pcpname":"PEDIATRICARE OF NORTHERN VIRGINIA PC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"703\/331-0959","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F90.0","Z79.899","Z09.","Z68.54","Z00.121","E88.81","Z13.31","Z00.129","R45.86","F32.81","E66.9","L83.","F90.2","F33.1","L60.0","L08.89","F90.9","T63.441A","M54.2","M21.41","M21.42","J30.89","H10.33","L71.0","R63.5"],"date":["2021-05-17","2021-05-17","2021-05-17","2021-05-17","2021-05-17","2021-10-15","2021-05-17","2020-05-14","2020-01-31","2020-01-31","2020-01-31","2021-10-15","2019-12-02","2019-12-02","2019-01-09","2019-01-09","2019-04-03","2019-08-21","2019-03-20","2019-03-20","2019-03-20","2019-08-27","2019-08-27","2019-08-27","2019-08-28"],"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":[["","","VYVANSE"," VYVANSE ","30","Select","Select",""],["","","METFORMIN"," METFORMIN ","30","Select","Select",""],["","","AMOXICILLIN"," AMOXICILLIN ","20","Select","Select",""],["","","FLUCONAZOLE"," FLUCONAZOLE ","1","Select","Select",""],["","","CEPHALEXIN"," CEPHALEXIN ","20","Select","Select",""],["","","CLONIDINE"," CLONIDINE ","30","Select","Select",""],["","","HYDROCORT"," HYDROCORT ","20","Select","Select",""],["","","POLYMYXIN"," POLYMYXIN ","10","Select","Select",""],["","","FLUTICASONE"," FLUTICASONE ","16","Select","Select",""],["","","ZADITOR"," ZADITOR ","5","Select","Select",""],["","","SERTRALINE","TAB 25MG","","Select","Select",""],["","","SMZ\/TMP","TAB 800-160","","Select","Select",""],["","","JUNEL","TAB 43831","","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":""}]}]}