{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JORDAN   C BRANCH","gend":1,"add":"5812 NEWTON ARCH APT 101","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"2003-03-17","age":"","mstatus":"","insh":"8579725*01","cliId":"","pno":"757\/469-8631","cno":"","email":"","ename":"","eno":"","pphy":"CHILDS, MARCELLA MD","ppno":"757\/499-7442","pcpadd":"SUITE 250 4505 COLUMBUS STREET","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":"","pcpname":"CMG - Children's Hospital of The King's Daughters - Town Center Pediatrics at Columbus","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/490-3638","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.419","J00.","F33.1","F41.1","F51.01","O36.8130","Z3A.28","H65.02","G43.909","J30.9","S30.860A","Z30.09","Z30.9","Z20.2","N76.0","F32.2","J10.1","R05.","R11.2","F34.1","F43.10","F32.9","R42.","R51."],"date":["2019-09-18","2020-01-13","2019-04-02","2019-07-06","2019-04-02","2021-04-29","2021-04-29","2019-03-28","2019-03-28","2019-03-28","2020-01-19","2020-04-27","2020-04-27","2020-04-27","2020-04-27","2019-04-06","2020-03-07","2020-03-14","2020-03-14","2019-02-23","2019-02-23","2019-09-27","2019-12-16","2019-12-16"],"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":[["","","VIORELE"," VIORELE ","28","Select","Select",""],["","","TRAZODONE"," TRAZODONE ","30","Select","Select",""],["","","FLUOXETINE"," FLUOXETINE ","30","Select","Select",""],["","","RIZATRIPTAN"," RIZATRIPTAN ","12","Select","Select",""],["","","NAPROXEN"," NAPROXEN ","60","Select","Select",""],["","","FLUTICASONE"," FLUTICASONE ","10","Select","Select",""],["","","CYPROHEPTAD"," CYPROHEPTAD ","30","Select","Select",""],["","","HYDROXYZ"," HYDROXYZ ","30","Select","Select",""],["","","EPINEPHRINE"," EPINEPHRINE ","2","Select","Select",""],["","","ERYTHROMYCIN"," ERYTHROMYCIN ","4","Select","Select",""],["","","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","","ROBITUSSIN","SYP 7.5\/5ML","","Select","Select",""],["","","AZURETTE","TAB 28 DAY","","Select","Select",""],["","","BROM\/PSE\/DM","SYP ","","Select","Select",""],["","","BENZONATATE","CAP 100MG","","Select","Select",""],["","","SMZ\/TMP","TAB 800-160","","Select","Select",""],["","","FLUCONAZOLE","TAB 150MG","","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":""}]}]}