{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALEXUS COPELAND","gend":1,"add":"100 OUTLAW ST PO BOX 15098","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"2004-07-04","age":"","mstatus":"","insh":"9574980*01","cliId":"","pno":"757\/920-1583","cno":"","email":"","ename":"","eno":"","pphy":"ASKINS, CRYSTAL N NP","ppno":"757\/488-2223","pcpadd":"STE 200A 4012 RAINTREE RD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23321,"pcpcounty":"","pcpid":"","pcpname":"Renaissance Pediatrics","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/488-8398","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F43.24","F43.23","R07.89","H00.14","F43.25","B34.9","R00.1","R51.9","H00.015","M94.0","Z30.8","Z20.822","F33.2","F90.2","M25.531","K21.9","F33.1","Z30.09","F32.9","Z32.02","S93.401A","S99.911A","Z30.40","Z70.8","F17.200","Z30.017","Z32.01","L29.9","Z97.5","Z30.46","R42.","R51.","R11.2","L25.9","M54.5","B86.","K12.1","Z62.820"],"date":["2021-12-13","2021-10-25","2021-11-05","2020-03-31","2021-06-02","2021-11-05","2021-11-05","2021-11-05","2020-02-17","2020-02-17","2020-03-03","2021-04-14","2021-06-28","2020-07-22","2020-09-29","2020-09-29","2020-02-18","2021-09-08","2020-10-16","2020-10-16","2021-12-20","2021-12-20","2021-12-08","2021-12-08","2021-12-08","2021-01-12","2021-01-12","2021-02-22","2021-02-22","2021-09-08","2019-02-12","2019-04-25","2019-02-12","2019-01-30","2019-03-27","2019-04-25","2019-04-25","2019-08-07"],"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":[["","11917010272","IBUPROFEN","CAP 200MG","80","Select","Select",""],["","00904672059","ACETAMIN","TAB 500MG","28","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","65862077685","MILI","TAB 0.25\/35","28","Select","Select",""],["","70700011985","ESTARYLLA","TAB 0.25-35","28","Select","Select",""],["","","ERYTHROMYCIN","OIN 5MG\/GM","","Select","Select",""],["","","NAPROXEN","TAB 500MG","","Select","Select",""],["","59762453701","MEDROXYPR","INJ 150MG\/ML","1","Select","Select",""],["","00168014630","HYDROCORT","OIN 0.025","28","Select","Select",""],["","","VOLTAREN","GEL 0.01","","Select","Select",""],["","","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","","DICLOFENAC","GEL 0.01","","Select","Select",""],["","50458058501","CONCERTA","TAB 18MG","30","Select","Select",""],["","00363031901","SOOTHE","CHW 262MG","12","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","45802026937","PERMETHRIN","CRE 0.05","60","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","62037072501","METHYLPHENID","TAB 18MG ER","30","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","15","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","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":""}]}]}