{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MANDY   M WALKER","gend":1,"add":"PO BOX 24","city":"HALIFAX","state":"VA","zip":"24558-9998","dob":"2003-11-24","age":"","mstatus":"","insh":"9083065*01","cliId":"","pno":"434\/476-1087","cno":"","email":"","ename":"","eno":"","pphy":"EBALO, NONNA L MD","ppno":"434\/572-3635","pcpadd":"2202 BEECHMONT ROAD","pcpcity":"SOUTH BOSTON","pcpstate":"VA","pcpzip":24592,"pcpcounty":"","pcpid":"","pcpname":"SOUTH BOSTON PEDIATRICS","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"000\/000-0000","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N39.0","Z88.1","N91.2","S06.0X0A","N83.201","R10.2","R10.13","F41.9","K58.1","K59.01","Z86.59","R35.0","R30.0","R10.30","R21.","J02.0","D48.5","Q82.5","N30.00","F41.1","Z20.828","J01.00","K59.00","E43.","I95.9","K56.7","Z79.899","N92.6","J45.909","F32.9","I49.8","Z83.79","R63.4","F54.","K59.09","B27.90","Z43.1","R10.0","G89.29","M54.5","R10.83","N83.10","R10.33","Z87.19","Z46.82","Z91.81","A09.","J11.1","Z00.121","R07.89","N18.9","R10.84","R11.0","R10.9","R13.10","K90.0","E55.9","R16.2"],"date":["2021-05-17","2021-05-17","2021-11-29","2021-07-25","2020-05-11","2020-05-15","2020-07-23","2020-01-15","2020-07-23","2020-07-23","2020-01-15","2020-04-22","2020-02-11","2020-09-18","2021-10-01","2020-02-11","2020-10-26","2020-07-17","2021-05-13","2021-10-06","2021-12-29","2020-03-10","2020-09-18","2019-02-07","2019-01-02","2019-01-03","2019-02-05","2019-01-02","2019-09-05","2019-05-20","2019-01-09","2019-01-02","2019-02-07","2019-01-08","2019-01-14","2019-11-25","2019-02-05","2019-05-16","2019-09-05","2019-09-05","2019-05-16","2019-05-16","2019-09-06","2019-09-10","2019-01-09","2019-01-09","2019-03-11","2019-03-11","2019-08-20","2019-01-02","2019-02-05","2019-09-04","2019-09-04","2019-09-05","2019-02-07","2019-02-20","2019-02-20","2019-11-25"],"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":[["","","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","20","Select","Select",""],["","59779061288","ALLERGY","TAB 10MG","30","Select","Select",""],["","00254302902","LUBIPROSTONE","CAP 24MCG","60","Select","Select",""],["","45802048678","DOCUSATE","CAP 100MG","60","Select","Select",""],["","59779030602","CVS","POW ","238","Select","Select",""],["","","EPIPEN","INJ 0.3MG","","Select","Select",""],["","00603497528","OXYBUTYNIN","TAB 5MG","60","Select","Select",""],["","00603020922","MAG","TAB 400MG","90","Select","Select",""],["","","AMITIZA","CAP 24MCG","","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","18","Select","Select",""],["","00115169449","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","30","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","","STOOL","CAP 100MG","","Select","Select",""],["","65862007601","CIPROFLOXACN","TAB 250MG","14","Select","Select",""],["","68462079817","TRIAMCINOLON","OIN 0.005","45","Select","Select",""],["","51645084003","PRENATAL","TAB ","30","Select","Select",""],["","13107015590","PAROXETINE","TAB 20MG","90","Select","Select",""],["","24658031205","DOXYCYCL","TAB 100MG","30","Select","Select",""],["","69097083412","SERTRALINE","TAB 50MG","30","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","21","Select","Select",""],["","50428305623","MILK","SUS 400\/5ML","150","Select","Select",""],["","","CEFDINIR","CAP 300MG","","Select","Select",""],["","","PHENAZOPYRID","TAB 200MG","","Select","Select",""],["","50428317857","GENTLE","TAB 5MG EC","20","Select","Select",""],["","00121072716","RANITIDINE","SYP 75MG\/5ML","300","Select","Select",""],["","49281041950","FLUZONE","INJ 2019-20","0","Select","Select",""],["","","CHLORD\/CLIDI","CAP 5-2.5MG","","Select","Select",""],["","","NITROFURANTN","CAP 100MG","","Select","Select",""],["","","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","51927901300","BASE","POW 1450","238","Select","Select",""],["","00555901658","SPRINTEC","TAB 28 DAY","28","Select","Select",""],["","00004080085","TAMIFLU","CAP 75MG","10","Select","Select",""],["","00574041207","POLYETH","POW 3350 NF","30","Select","Select",""],["","00904792780","BISACODYL","TAB 5MG EC","30","Select","Select",""],["","37864000104","ACETAMIN","TAB 500MG","100","Select","Select",""],["","43386031208","GAVILAX","POW ","238","Select","Select",""],["","49100040007","CULTURELLE","CAP ","14","Select","Select",""],["","70710101002","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","67253090050","ALPRAZOLAM","TAB 0.25MG","60","Select","Select",""],["","59762453701","MEDROXYPR","INJ 150MG\/ML","1","Select","Select",""],["","50428470490","DUAL","CHW COMPLETE","20","Select","Select",""],["","51991083801","CYPROHEPTAD","TAB 4MG","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":""}]}]}