{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KELSEY RIVERS","gend":1,"add":"113 PICARD DR","city":"NEWPORT NEWS","state":"VA","zip":"23602-9998","dob":"2004-04-20","age":"","mstatus":"","insh":"9473343*01","cliId":"","pno":"757\/879-9445","cno":"757\/782-7527","email":"","ename":"","eno":"","pphy":"OBROKTA, DEENA S DO","ppno":"757\/668-4800","pcpadd":"12705 MCMANUS BOULEVARD","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23602,"pcpcounty":"","pcpid":"","pcpname":"CMG - Children's Hospital of The King's Daughters - Liberty Pediatrics","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/668-4828","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","F41.9","Z30.431","Z11.3","F32.9","F43.10","F12.20","D22.9","B07.9","V62.84","Z00.129","Z68.54","Z23.","Z71.3","Z13.31","Z71.82","R52.","R10.9","R11.0","F31.81","F41.1","F12.99","R11.2","R19.7","R10.84","Z79.899","R42.","J02.0","K52.9","R10.12","R10.11","R07.9","S61.512A","K59.00","N94.6","Z91.011","K20.9","K29.00","R10.13","R10.33","F05.","Z30.430","Z09.","M54.9","Z20.822","T43.222A","F12.90","D72.829","R13.14","R53.83","N62.","N64.81","Z68.53","J02.9","H00.014","G47.9","Z30.09","R51.9","Z20.828"],"date":["2021-02-04","2021-10-06","2020-03-17","2020-03-17","2021-12-08","2021-12-31","2021-05-08","2020-10-22","2020-10-22","2021-05-08","2021-06-08","2021-06-08","2021-10-12","2021-06-08","2021-12-08","2021-06-08","2021-07-07","2021-10-12","2021-10-12","2021-12-15","2021-12-15","2021-12-15","2021-10-06","2021-10-06","2021-10-06","2021-10-06","2021-10-06","2019-05-01","2021-03-22","2021-03-22","2021-03-22","2021-05-08","2021-06-13","2019-10-29","2019-12-12","2019-10-29","2020-01-29","2020-01-29","2020-01-29","2021-12-08","2021-05-08","2019-12-31","2021-03-31","2021-03-31","2021-05-08","2021-05-08","2021-05-08","2021-05-08","2021-12-08","2019-12-18","2021-06-28","2021-06-28","2020-04-22","2021-07-07","2021-07-12","2021-12-08","2019-12-12","2020-11-08","2020-11-08"],"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":[]},{"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":[["","","SERTRALINE"," SERTRALINE ","30","Select","Select",""],["","","HYOSCYAMINE"," HYOSCYAMINE ","60","Select","Select",""],["","","FLUCONAZOLE","TAB 50MG","","Select","Select",""],["","","ONDANSETRON","TAB 4MG","","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":""}]}]}