{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TY  L ASHBERRY","gend":0,"add":"340 GOLDEN MAPLE DR","city":"VIRGINIA BEACH","state":"VA","zip":23452,"dob":"1994-01-18","age":"","mstatus":"","insh":"9634924*01","cliId":"","pno":"747-0878","cno":"","email":"","ename":"","eno":"","pphy":"Route,  barbara","ppno":"757\/668-2200","pcpadd":"5424 Discovery Park Blvd BLDB A STE 201","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23452,"pcpcounty":"","pcpid":"","pcpname":"CMG - Children's Hospital of The King's Daughters - Hampton Roads Pediatrics","plan":"OHP","program":"Medicaid","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/668-2222","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S02.609A","R22.0","V54.19","Z86.39","V62.84","F10.94","E10.9","Z96.41","F10.20","F31.9","F31.32","F19.10","M27.2","NO DATA","F41.9","E10.65","Z79.4","F10.920","E11.65","R10.13","E86.0","E10.10","M86.60","K92.1","R19.7","R19.5","R15.2","R19.4","E10.40"],"date":["2020-06-08","2020-03-01","2020-03-01","2020-03-01","2020-03-16","2020-03-16","2020-07-03","2020-03-15","2020-06-02","2020-06-02","2020-06-14","2020-06-02","2021-06-17","2021-06-17","2020-02-11","2020-07-03","2020-07-03","2020-03-16","2021-05-31","2021-06-15","2021-06-15","2021-06-15","2020-02-19","2020-05-26","2020-05-26","2020-05-26","2020-05-26","2020-05-26","2020-03-14"],"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":[["","","BUSPIRONE","TAB 15MG","","Select","Select",""],["","","AMOX\/K","TAB 875-125","","Select","Select",""],["","","NOVOLOG","INJ FLEXPEN","","Select","Select",""],["","","LANTUS","INJ 100\/ML","","Select","Select",""],["","","BD  PEN NEEDL","MIS 32GX4MM","","Select","Select",""],["","","CONTOUR","TES NEXT","","Select","Select",""],["","","CHLORHEX","SOL 0.0012","","Select","Select",""],["","","FIASP","INJ TOUCH","","Select","Select",""],["","","CLINDAMYCIN","CAP 300MG","","Select","Select",""],["","","GLUCAGON","KIT 1MG","","Select","Select",""],["","","OXCARBAZEPIN","TAB 150MG","","Select","Select",""],["","","NALTREXONE","TAB 50MG","","Select","Select",""],["","","DISULFIRAM","TAB 500MG","","Select","Select",""],["","","NOVOLIN","INJ U-100","","Select","Select",""],["","","INSULIN","INJ FLEXPEN","","Select","Select",""],["","","AMOXICILLIN","CAP 500MG","","Select","Select",""],["","","HUMALOG","INJ 100\/ML","","Select","Select",""],["","","TRAZODONE","TAB 50MG","","Select","Select",""],["","","IBUPROFEN","TAB 600MG","","Select","Select",""],["","","HYDROXYZ","CAP 25MG","","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}