{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANARI L MUNSON","gend":1,"add":"220 CRANE CIR APT A","city":"NEWPORT NEWS","state":"VA","zip":"23608-9998","dob":"2001-12-19","age":"","mstatus":"","insh":"20032580*01","cliId":"","pno":7576962310,"cno":7576962310,"email":"","ename":"","eno":"","pphy":"WEBB, ELIZABETH K NP","ppno":7576687243,"pcpadd":",","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23507-9998","pcpcounty":"","pcpid":"","pcpname":"CMG - Children's Hospital of The King's Daughters - Coastal Pediatrics","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7576687811,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D57.1","Z79.899","R11.0","K80.20","K80.10","D57.00","M25.562","M79.601","M79.661","T88.7XXA","A41.9","D72.825","Z20.822","D64.9","N17.9","R09.02","R80.9","J45.50","F40.10","K59.03","R50.9","Z01.818","Z86.2","Z88.8","Z88.0","J45.909","I95.89","N17.8","E86.0","R65.21","I95.2","H93.19","N08.","R03.0","Z82.5","Z83.2","Z82.49","Z84.89","NO DATA","D57.01","M86.8X6","R50.81","L29.9","T40.2X5A","M60.9","Z90.49","J20.8","T40.605A","G43.909","D72.829","D57.819","R00.0","Z74.01","Z51.81","N14.1","R11.2","R19.7","I95.9","R16.0","E80.6","R63.3","Z79.51","N28.9","Z01.812","M79.621","R51.9","J98.11","I10.","E55.9","Z82.0","R53.83","R07.9","M62.81","D57.211","R10.9","G89.4","D57.3","N18.9","M79.602","M54.9","Z51.89","M79.604","R41.82","D50.8","E87.5","E86.1","R65.10","D57.80","M89.8X9","Z91.14","L81.0","Z78.9","M79.605","I95.0","R52.","R06.02","Z79.01","Z91.148","J16.8","E83.111","Z79.64","Z91.199","R07.89"],"date":["2023-09-07","2023-09-19","2022-03-23","2021-05-05","2021-05-06","2023-09-19","2021-08-02","2022-01-07","2022-01-11","2022-01-07","2022-09-11","2022-08-17","2022-08-17","2022-09-11","2022-09-14","2023-05-05","2023-09-07","2023-06-15","2022-10-26","2023-05-05","2023-01-11","2021-05-05","2021-05-05","2022-03-23","2022-09-11","2022-08-18","2022-01-23","2022-09-11","2022-09-11","2022-09-11","2022-09-11","2022-09-11","2023-05-05","2022-09-11","2022-09-11","2022-09-11","2022-09-11","2022-09-11","2022-12-31","2023-05-05","2022-12-31","2022-12-31","2022-12-31","2022-12-31","2022-12-31","2023-05-05","2022-12-31","2023-05-05","2023-05-05","2022-03-22","2021-08-11","2022-01-22","2021-08-11","2023-04-24","2022-01-22","2022-03-24","2022-03-24","2022-01-22","2021-01-13","2021-01-13","2021-01-13","2021-04-25","2021-01-19","2021-04-05","2022-01-11","2022-03-23","2022-03-23","2022-03-23","2022-12-12","2022-03-23","2023-05-05","2023-05-04","2023-01-17","2023-01-17","2022-03-23","2021-04-26","2021-05-06","2022-01-22","2022-01-22","2021-08-11","2021-11-19","2022-01-11","2022-01-22","2022-01-22","2022-01-22","2022-01-22","2022-08-18","2022-08-18","2022-12-12","2021-08-02","2022-02-03","2022-02-03","2022-09-01","2022-09-14","2023-04-24","2023-05-05","2023-05-05","2023-05-05","2023-05-04","2023-09-07","2023-06-15","2023-09-07","2023-09-19"],"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":[["","10702001801","OXYCODONE","TAB 5MG","20","Select","Select",""],["","57237009960","CEFDINIR","300 MG","16","Select","Select",""],["","57896044101","BISACODYL","TAB 5MG EC","30","Select","Select",""],["","0","COMPOUND"," ","540","Select","Select",""],["","72786010101","OXBRYTA","TAB 500MG","90","Select","Select",""],["","67877067001","MORPHINE SUL","TAB 15MG","30","Select","Select",""],["","75834002001","VITAMIN D3","CAP 50000UNT","9","Select","Select",""],["","71770012030","SIKLOS","TAB 1000MG","53","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","30","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","45802086803","POLYETH GLYC","POW 3350 NF","510","Select","Select",""],["","11822039970","RA LAXATIVE","TAB 5MG EC","30","Select","Select",""],["","57896020110","PAIN RELIEF","TAB 500MG","100","Select","Select",""],["","00904530660","BANOPHEN","CAP 25MG","30","Select","Select",""],["","42806054701","VITAMIN D","2 1250 MCG","8","Select","Select",""],["","11534016501","FOLIC ACID","1 MG","30","Select","Select",""],["","65162046450","IBUPROFEN","TAB 400MG","20","Select","Select",""],["","11822330270","ARTHRTS PAIN","TAB 650MG","100","Select","Select",""],["","43547035110","LISINOPRIL","2.5 MG","90","Select","Select",""],["","43386031214","GAVILAX","POW ","510","Select","Select",""],["","29300041301","CYCLOBENZAPR","TAB 5MG","15","Select","Select",""],["","00085720601","DULERA","100-5 MCG","13","Select","Select",""],["","00536111825","ARTH PAIN","CRE 0.00075","57","Select","Select",""],["","17478076206","DRONABINOL","CAP 5MG","60","Select","Select",""],["","31722072320","LEVOFLOXACIN","TAB 750MG","3","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","00781717612","NALOXONE","SPR ","2","Select","Select",""],["","59746011306","PROCHLORPER","TAB 5MG","21","Select","Select",""],["","00003633717","DROXIA","400 MG","135","Select","Select",""],["","00904530661","DIPHENHYDRAM","CAP 25MG","30","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00363010706","WAL-DRYL","CAP 25MG","30","Select","Select",""],["","29300022019","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","00093216568","NALOXONE HCL","SPR ","2","Select","Select",""],["","16729056301","HYDROXYCHLOR","TAB 400MG","120","Select","Select",""],["","00113046262","ALLERGY RELF","CAP 25MG","30","Select","Select",""],["","00406324401","HYDROMORPHONE HCL","4 MG","60","Select","Select",""],["","63304069201","CLINDAMYCIN HCL","150 MG","100","Select","Select",""],["","42858080101","MORPHINE SULFATE ER","15 MG","76","Select","Select",""],["","70710127703","DEFERASIROX","360 MG","90","Select","Select",""],["","00536252525","CAPSAICIN","0.025 %","120","Select","Select",""],["","50111078710","AZITHROMYCIN","250 MG","2","Select","Select",""],["","00085720601","DULERA AER","100-5MCG","13","Select","Select",""],["","00832027311","MORPHINE SUL TAB","15MG","60","Select","Select",""],["","00536111825","ARTH PAIN CRE","0.075%","57","Select","Select",""],["","43547035110","LISINOPRIL TAB","2.5MG","30","Select","Select",""],["","71770012030","SIKLOS TAB","1000MG","53","Select","Select",""],["","65162046450","IBUPROFEN TAB","400MG","20","Select","Select",""],["","29300041301","CYCLOBENZAPR TAB","5MG","15","Select","Select",""],["","17478076206","DRONABINOL CAP","5MG","60","Select","Select",""],["","00406055201","OXYCODONE TAB","5MG","30","Select","Select",""],["","00904530661","DIPHENHYDRAM CAP","25MG","30","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","00781717612","NALOXONE SPR","","2","Select","Select",""],["","00904530660","BANOPHEN CAP","25MG","30","Select","Select",""],["","64380073706","VITAMIN D CAP","50000UNT","9","Select","Select",""],["","59746011306","PROCHLORPER TAB","5MG","21","Select","Select",""],["","66993001968","ALBUTEROL AER HFA","","18","Select","Select",""],["","00003633717","DROXIA CAP","400MG","120","Select","Select",""],["","57896044101","BISACODYL TAB","5MG EC","30","Select","Select",""],["","65862039010","ONDANSETRON TAB","4MG ODT","30","Select","Select",""],["","31722072320","LEVOFLOXACIN TAB","750MG","3","Select","Select",""],["","11534016501","FOLIC ACID TAB","1MG","30","Select","Select",""],["","11822330270","ARTHRTS PAIN TAB","650MG","100","Select","Select",""],["","00093216568","NALOXONE HCL SPR","4MG","2","Select","Select",""],["","00363010706","WAL-DRYL CAP","25MG","30","Select","Select",""],["","29300022019","MONTELUKAST TAB","10MG","30","Select","Select",""],["","16729056301","HYDROXYCHLOR TAB","400MG","120","Select","Select",""],["","00113046262","ALLERGY RELF CAP","25MG","30","Select","Select",""],["","70710166701","PROCHLORPERAZINE MALEATE","5 MG","21","Select","Select",""],["","29300022019","MONTELUKAST SODIUM","10 MG","90","Select","Select",""],["","51660033301","ARTHRITIS PAIN RELIEF","650 MG","100","Select","Select",""],["","49884072401","HYDROXYUREA","500 MG","104","Select","Select",""],["","65862018830","ONDANSETRON HCL","8 MG","20","Select","Select",""],["","29300041301","CYCLOBENZAPRINE HCL","5 MG","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":""}]}]}