{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"YLLONNIE   A HAMLIN","gend":1,"add":"400 WHITWORTH WAY APT 100","city":"WILLIAMSBURG","state":"VA","zip":"23185-9998","dob":"2003-03-18","age":"","mstatus":"","insh":"8765294*01","cliId":"","pno":"757\/268-2029","cno":"","email":"","ename":"","eno":"","pphy":"GOTTFRIED, LINDA MD","ppno":"757\/253-5757","pcpadd":"SUITE 202 4374 NEW TOWN AVE","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23188,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Pediatric Physicians - New Town","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/510-9063","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H10.13","J30.1","J30.9","Z79.899","F32.2","F90.0","R41.840","V62.84","G47.9","R63.0","S93.402A","J45.909","NO DATA","R26.89","H10.9","G47.10","F51.04","R06.83","M25.572","J01.10","J02.9","R05.","R09.81","H10.33","J01.40","S63.502A","S69.82XA","M25.532","V58.89","M25.539"],"date":["2021-04-14","2021-04-14","2021-04-14","2021-11-20","2021-10-14","2021-10-14","2021-10-14","2021-10-14","2021-10-07","2021-10-07","2021-11-20","2021-11-20","2021-11-20","2021-11-20","2021-10-18","2021-07-19","2021-06-23","2021-07-19","2021-11-20","2019-09-30","2019-09-30","2019-09-30","2019-09-30","2019-09-30","2019-01-08","2019-05-09","2019-07-12","2019-11-07","2019-09-23","2019-06-05"],"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":[["","","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","61314023710","CROMOLYN","SOL 4% OP","10","Select","Select",""],["","00093768432","OLOPATADINE","SOL 0.002","2","Select","Select",""],["","00228305911","AMPHET\/DEXTR","CAP 10MG ER","30","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","54092038301","ADDERALL","CAP 10MG","30","Select","Select",""],["","24208031510","POLYMYXIN","SOL TRIMETHP","10","Select","Select",""],["","69097083512","SERTRALINE","TAB 100MG","30","Select","Select",""],["","00536100901","FERROUS","TAB 325MG","60","Select","Select",""],["","00093416173","AMOXICILLIN","SUS 400\/5ML","200","Select","Select",""],["","","SUDAFED","LIQ 15MG\/5ML","","Select","Select",""],["","67877032005","IBUPROFEN","TAB 600MG","40","Select","Select",""],["","50428039131","ALLERGY","TAB 60-120MG","20","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","41167431004","ALLEGRA-D","TAB 12 HOUR","20","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","30","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":""}]}]}