{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ZNIAH HENDERSON","gend":1,"add":"13225 AQUEDUCT DR APT 5","city":"NEWPORT NEWS","state":"VA","zip":"23602-9998","dob":"2004-12-03","age":"","mstatus":"","insh":"9782567*01","cliId":"","pno":"757\/594-6012","cno":"","email":"","ename":"","eno":"","pphy":"STAPLETON, MACY LERIN NP","ppno":"757\/838-8166","pcpadd":"2101 EXECUTIVE DRIVE SUITE 160","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":"","pcpname":"ASSOCIATES IN PEDIATRIC CARE-HAMPTON LLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/838-8233","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R39.81","R15.1","R15.9","R10.9","Z13.31","Z13.39","Z78.9","F32.1","F41.1","G47.411","F32.0","Z72.820","H60.91","H92.01","F43.23","K59.01","R45.4","G47.419","Z63.8","R10.33","N91.2","F41.8","F43.20","N91.1","E28.2","Z30.011","Z20.822","B37.2","K59.00","Z13.89","F41.9","R32.","Z00.121","S60.512A","X58.XXXA","F32.9","Z23.","J30.9","Z71.3","Z71.82","Z68.52","Z79.899","F51.5","R44.0","G47.19","F43.9","K21.9","N92.5","N76.0","Z76.89","G47.00","G47.33","J30.1","L70.9","R53.83","R06.83","G47.9","S93.402A","S93.602A","W22.8XXA","J32.9","H93.93","R25.3","R25.9","L70.0","Z71.9","G47.10","R25.1","E78.89"],"date":["2021-05-01","2021-05-01","2021-05-01","2021-07-06","2021-10-08","2021-08-27","2021-10-15","2021-07-08","2021-10-15","2021-10-15","2021-08-06","2021-08-27","2020-04-26","2020-04-26","2020-10-26","2021-05-10","2021-07-01","2021-09-09","2021-10-15","2020-01-24","2020-01-24","2021-02-10","2020-10-22","2021-03-05","2021-03-05","2021-03-05","2021-09-11","2021-10-08","2021-10-08","2021-10-08","2021-09-09","2020-12-01","2021-06-22","2021-06-22","2021-06-22","2021-07-15","2021-06-22","2021-06-22","2021-07-21","2021-07-21","2021-06-22","2021-06-22","2021-08-27","2021-09-09","2020-03-11","2021-07-07","2021-07-06","2020-11-06","2020-06-09","2020-06-09","2021-04-27","2019-11-06","2019-02-05","2019-03-27","2019-10-23","2019-11-06","2019-11-06","2019-01-29","2019-01-29","2019-01-29","2019-05-03","2019-11-22","2019-02-19","2019-02-19","2019-10-28","2019-10-28","2019-02-12","2019-02-12","2021-07-21"],"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":[["","65862001330","SERTRALINE","TAB 100MG","60","Select","Select",""],["","","METHYLPHENID","TAB 27MG ER","","Select","Select",""],["","45802004835","NYSTATIN","OIN 100000","60","Select","Select",""],["","68180089173","ENSKYCE","TAB ","84","Select","Select",""],["","","CONCERTA","TAB 27MG","","Select","Select",""],["","","RA"," RA ","1020","Select","Select",""],["","","MEDROXYPR","TAB 10MG","","Select","Select",""],["","00135057603","FLONASE","SPR 50MCG","16","Select","Select",""],["","60432026415","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","45802005535","TRIAMCINOLON","OIN 0.001","30","Select","Select",""],["","","POLYETH"," POLYETH ","527","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","11822316450","LORATADINE","TAB 10MG","90","Select","Select",""],["","","CLINDAMYCIN"," CLINDAMYCIN ","60","Select","Select",""],["","","BP"," BP ","113","Select","Select",""],["","","BENZOYL"," BENZOYL ","237","Select","Select",""],["","","CYPROHEPTAD"," CYPROHEPTAD ","90","Select","Select",""],["","","AZITHROMYCIN"," AZITHROMYCIN ","45","Select","Select",""],["","","TRETINOIN"," TRETINOIN ","45","Select","Select",""],["","","RETIN-A"," RETIN-A ","45","Select","Select",""],["","","CIPRODEX","SUS 0.3-0.1%","","Select","Select",""],["","","FLUCONAZOLE","SUS 40MG\/ML","","Select","Select",""],["","","PEG3350","POW ","","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":""}]}]}