{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAHEIM VANWROTEN","gend":0,"add":"2611 GAY AVE","city":"HENRICO","state":"VA","zip":"23231-9998","dob":"2004-05-18","age":"","mstatus":"","insh":"2131152*01","cliId":"","pno":"804\/321-1414","cno":"","email":"","ename":"","eno":"","pphy":"NYIRENDA, FAFA MD","ppno":"804\/730-4690","pcpadd":"7347 BELL CREEK ROAD SUITE 100","pcpcity":"MECHANICSVILLE","pcpstate":"VA","pcpzip":23111,"pcpcounty":"","pcpid":"","pcpname":"BON SECOURS EAST END PEDIATRICS","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/559-0333","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z20.828","F41.1","F51.01","F33.0","F90.0","J03.00","L03.213","Z68.52","F43.21","Z79.899","Z79.51","F60.89","F41.0","F41.9","G47.00","R03.0","S60.229A","M79.643","NO DATA","E55.9","R63.0","Z00.121","Z72.51","R45.86","B36.0","J45.20","Z13.31","M79.644","V62.84"],"date":["2021-08-06","2022-05-16","2022-05-16","2022-05-16","2022-05-16","2021-08-06","2020-02-21","2022-01-21","2022-02-18","2022-02-18","2022-02-18","2022-02-18","2022-03-03","2022-03-03","2022-03-03","2021-11-19","2022-04-12","2022-04-12","2022-03-03","2022-01-21","2022-01-21","2020-01-20","2020-01-20","2020-01-20","2020-01-20","2020-01-20","2022-03-03","2022-03-03","2022-03-03"],"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":[["","00115180301","HYDROXYZ","CAP 25MG","30","Select","Select",""],["","29300046810","CLONIDINE","TAB 0.1MG","30","Select","Select",""],["","00115175701","CYPROHEPTAD","TAB 4MG","30","Select","Select",""],["","68180035103","SERTRALINE","TAB 25MG","30","Select","Select",""],["","00904615760","VITAMIN","TAB 2000UNIT","30","Select","Select",""],["","60505265301","TRAZODONE","TAB 50MG","30","Select","Select",""],["","31604002674","D3","TAB 2000UNIT","30","Select","Select",""],["","35573041830","ATOMOXETINE","CAP 40MG","30","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","59310057922","PROAIR","AER ","17","Select","Select",""],["","00093321992","KETOCONAZOLE","CRE 0.02","120","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","36","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","20","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","30","Select","Select",""],["","00406012405","HYDROCO\/APAP","TAB 7.5-325","14","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":""}]}]}