{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LATASHA C LITTLE","gend":1,"add":"1322 MACDONALD ROAD C","city":"CHESAPEAKE","state":"VA","zip":"23325-9998","dob":"1988-04-06","age":"","mstatus":"","insh":"2334690*01","cliId":"","pno":7574519099,"cno":7574519099,"email":"","ename":"","eno":"","pphy":"DE TRIQUET, JOHN M MD","ppno":7574616342,"pcpadd":"SUITE 200 885 KEMPSVILLE RD,","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23502-9998","pcpcounty":"","pcpid":"","pcpname":"CMG - Children's Hospital of The King's Daughters - Pediatric Specialists - Grassfield Office","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7574618507,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.2","N83.202","A74.9","R10.2","N83.9","K35.80","NO DATA","F31.31","O73.0","F33.1","M47.22","F17.210","Z88.2","R20.2","K04.7","O80.","O75.9","F31.60","F43.10","F12.20","F10.10","K37.","F90.9","F31.9","F41.1","Z79.899","F33.3","F31.32","F90.0","M54.2","M54.12","G24.3","Z36.9","Z36.89","F41.9","R87.612","F34.1","V23.41","Z98.890","Z63.8","O36.4XX0","Z3A.20","V23.7","Z09.","N70.11"],"date":["2022-06-12","2021-03-25","2021-03-25","2021-03-25","2021-03-25","2021-03-26","2021-03-26","2022-09-09","2021-03-03","2021-05-05","2022-06-09","2022-06-09","2022-06-09","2022-06-09","2023-06-13","2021-03-03","2021-03-03","2021-03-16","2022-02-24","2021-03-16","2021-03-16","2021-03-26","2021-12-09","2022-02-24","2022-02-24","2022-02-01","2021-11-15","2021-07-08","2021-07-08","2022-06-16","2022-06-16","2022-04-24","2021-01-08","2021-01-08","2021-01-08","2021-01-08","2021-01-08","2021-01-08","2021-01-08","2021-01-08","2021-03-03","2021-03-03","2021-03-03","2021-03-29","2021-03-29"],"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":[["","61874013020","VRAYLAR","CAP 3MG","30","Select","Select",""],["","68180013501","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","20","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","40","Select","Select",""],["","70954005920","PREDNISONE","TAB 10MG","26","Select","Select",""],["","67877032005","IBUPROFEN","600 MG","30","Select","Select",""],["","42571016242","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","20","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":""}]}]}