{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANTHONY   J ALLEN","gend":0,"add":"907 OHIO ST","city":"CHESAPEAKE","state":"VA","zip":"23324-9998","dob":"2003-10-30","age":"","mstatus":"","insh":"8968675*01","cliId":"","pno":"757\/319-7396","cno":"","email":"","ename":"","eno":"","pphy":"DREWES, ADAM MD","ppno":"757\/668-6500","pcpadd":"BLDG B 171 KEMPSVILLE RD","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23502,"pcpcounty":"","pcpid":"","pcpname":"CMG - Children's Hospital of The King's Daughters - Tidewater Children's Associates","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/668-6506","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M79.601","F39.","F34.81","L70.8","F33.9","J45.20","M25.572","M79.672","F90.9","F41.9","J45.909","Z79.899","S86.012A","S06.0X1A","S89.92XA","R07.89","F90.2","S52.125A","V62.84","F91.3","F12.10","G43.909","K13.79","Z55.0","T71.192A","I16.0","F31.9","F32.89","Z20.822","Z91.030","Z91.09","H61.23","F99.","R05.","R06.2","T43.592A","S63.612A","S52.132A","V00.131A"],"date":["2019-11-09","2020-01-23","2022-04-04","2021-10-30","2021-10-30","2021-10-30","2019-03-05","2019-03-05","2020-09-26","2019-03-05","2021-10-30","2019-03-05","2019-03-05","2019-09-22","2019-09-22","2019-09-22","2022-04-04","2019-04-10","2021-10-30","2021-10-30","2021-10-30","2021-10-30","2019-12-12","2020-01-23","2020-09-25","2020-09-25","2020-09-25","2020-09-26","2021-10-14","2021-10-14","2021-10-14","2021-10-21","2020-09-25","2021-01-06","2021-01-06","2021-10-28","2019-11-11","2019-04-15","2019-04-15"],"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":[["","","FLUOXETINE"," FLUOXETINE ","30","Select","Select",""],["","","AMPHET\/DEXTR"," AMPHET\/DEXTR ","60","Select","Select",""],["","","HYDROXYZ"," HYDROXYZ ","60","Select","Select",""],["","","CLONIDINE"," CLONIDINE ","30","Select","Select",""],["","","OXCARBAZEPIN"," OXCARBAZEPIN ","60","Select","Select",""],["","11877001140","BINAXNOW","KIT HOME TES","2","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","15","Select","Select",""],["","68180016006","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","","PROVENTIL","AER HFA","","Select","Select",""],["","","NAPROXEN","TAB 375MG","","Select","Select",""],["","","VENTOLIN","AER ","","Select","Select",""],["","","SUMATRIPTAN","TAB 25MG","","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","13668013701","ESCITALOPRAM","TAB 20MG","30","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","","PRAVASTATIN","TAB 10MG","","Select","Select",""],["","","AMOXICILLIN","CAP 500MG","","Select","Select",""],["","","POLYETH","POW 3350 NF","","Select","Select",""],["","","ACNE","CRE 0.1","","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":""}]}]}