{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"IYANNA   C CUBILLAN","gend":1,"add":"3636 PATSY ANN DR","city":"RICHMOND","state":"VA","zip":"23234-9998","dob":"2004-05-15","age":"","mstatus":"","insh":"2190232*01","cliId":"","pno":"804\/755-7417","cno":"","email":"","ename":"","eno":"","pphy":"WILSON, CRISTI S MD","ppno":"804\/282-7051","pcpadd":"STE 102 7605 FOREST AVE","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23229,"pcpcounty":"","pcpid":"","pcpname":"HENRICO PEDIATRICS PC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/288-5464","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","J06.9","G43.011","J45.20","F41.9","F32.0","Z01.419","Z30.9","M94.0","R07.89","J30.9","Z68.54","R05.","E66.9","Z71.3","S00.83XA","R51.9","Z20.828","S93.502A","J45.909","R41.0","F79.","G43.019","R10.9","R07.1","J45.41","E66.09","Q18.9","Z09.","J45.901","R06.2","M77.9","J45.21","Z23.","E88.81","E78.5","Z00.129","F33.9","M77.8","M79.641","M65.4"],"date":["2021-12-28","2020-03-28","2021-03-29","2021-03-29","2021-03-29","2021-03-29","2021-11-01","2021-11-01","2021-11-15","2021-11-15","2020-04-10","2020-04-10","2020-04-10","2020-03-24","2020-03-24","2020-03-05","2021-01-07","2021-10-15","2021-10-06","2020-03-05","2020-03-05","2020-08-06","2021-03-29","2021-10-15","2021-11-15","2021-12-14","2019-08-01","2019-08-01","2019-12-09","2019-10-03","2019-10-03","2019-12-23","2019-09-24","2019-09-24","2019-12-09","2019-12-09","2019-08-13","2019-08-13","2019-10-21","2019-10-21","2019-12-23"],"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":[["","51991036378","RIZATRIPTAN","TAB 10MG ODT","9","Select","Select",""],["","00254100752","ALBUTEROL","AER HFA","7","Select","Select",""],["","65862001205","SERTRALINE","TAB 50MG","30","Select","Select",""],["","59762453802","MEDROXYPR","INJ 150MG\/ML","1","Select","Select",""],["","55111029236","SUMATRIPTAN","TAB 50MG","9","Select","Select",""],["","","CETIRIZINE","TAB 10MG","","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00173071920","FLOVENT","AER 110MCG","12","Select","Select",""],["","00054001825","PREDNISONE","TAB 20MG","15","Select","Select",""],["","00378967130","IPRATROPIUM\/","SOL ALBUTER","90","Select","Select",""],["","00143312610","DICYCLOMINE","CAP 10MG","28","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","68382071782","ZOLMITRIPTAN","TAB 5MG ODT","9","Select","Select",""],["","70461032103","FLUCLVX","INJ 2021-22","0","Select","Select",""],["","","DRYSOL","SOL 0.2","","Select","Select",""],["","","IBUPROFEN","TAB 600MG","","Select","Select",""],["","","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","11917012698","VITAMIN","CAP 2000UNIT","30","Select","Select",""],["","00228285311","GUANFACINE","TAB 3MG ER","30","Select","Select",""],["","49884093547","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","68462018905","NAPROXEN","TAB 375MG","15","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":""}]}]}