{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ADRIANA WILLIAMS","gend":1,"add":"2214 PEACH ST","city":"PORTSMOUTH","state":"VA","zip":23704,"dob":"2002-12-02","age":"","mstatus":"","insh":"8351139*01","cliId":"","pno":"757\/297-9815","cno":"","email":"","ename":"","eno":"","pphy":"Palmer, Dionne","ppno":"757\/668-7400","pcpadd":"401 Gresham Drive ","pcpcity":"Norfolk","pcpstate":"VA","pcpzip":23704,"pcpcounty":"","pcpid":"","pcpname":"CMG - Children's Hospital of The King's Daughters - General Academic Pediatrics","plan":"OHP","program":"Medicaid","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/668-9810","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L03.113","Z30.431","R10.2","Z11.3","E11.9","N83.202","N83.201","Z30.09","Z86.19","R06.9","Z20.828","Q66.89","M25.572","N73.9","A74.9","Z30.430","N89.8","Z30.432","Z30.9","A41.9","A54.9","J45.909","Z09.","I10.","E66.9","M54.6","S50.311A","S20.219A","S00.81XA","R06.02","Y04.0XXA","M54.9","R03.0","R51."],"date":["2021-05-09","2021-12-10","2021-12-06","2021-08-20","2021-08-20","2021-12-10","2021-12-10","2021-02-26","2021-02-26","2021-09-09","2021-01-16","2020-02-14","2020-02-14","2021-12-06","2021-03-31","2021-03-31","2021-03-31","2021-12-17","2021-12-17","2021-09-09","2019-01-09","2019-01-09","2019-01-09","2019-09-04","2019-09-04","2019-10-14","2019-05-17","2019-05-17","2019-05-17","2019-05-17","2019-05-17","2019-10-14","2019-03-21","2019-05-17"],"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":[["","59310057922","PROAIR","AER ","17","Select","Select",""],["","59762372001","ALPRAZOLAM","TAB 0.5MG","2","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","70710112307","DOXYCYC","TAB 100MG","14","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","17","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}