{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CAMERON  J SHAW","gend":0,"add":"1629 KETTLE TERRACE CIRS","city":"CHESAPEAKE","state":"VA","zip":"23322-9998","dob":"2002-07-13","age":"","mstatus":"","insh":"2371982*01","cliId":"","pno":7574105151,"cno":7574105151,"email":"","ename":"","eno":"","pphy":"CHERRY, ALKA P MD","ppno":7576682500,"pcpadd":"500 DISCOVERY DR STE 302,","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":"23320-9998","pcpcounty":"","pcpid":"","pcpname":"CMG - Children's Hospital of The King's Daughters - Chesapeake Pediatrics","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7576682540,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K21.9","K59.00","R11.2","Z93.3","Q05.9","J45.20","Z88.2","Z88.1","Z91.040","Z01.812","Z20.822","R10.9","R10.13","R11.0","R11.11","M21.071","M21.6X1","F32.1","R26.1","Q05.7","M79.672","R20.8","M25.571","R12.","L21.9","Z71.9","Z96.9","Z13.31","K59.2","Q05.8","M25.561","S91.301A","N50.82","N45.1","H92.02","H60.502"],"date":["2022-01-07","2021-08-09","2021-08-09","2022-01-07","2022-06-23","2021-08-09","2021-08-09","2021-08-09","2021-08-09","2021-08-09","2021-08-09","2021-08-09","2021-08-09","2021-08-09","2021-08-09","2023-03-17","2023-03-17","2021-08-11","2022-08-03","2022-08-03","2022-02-09","2022-08-03","2022-12-02","2021-06-29","2022-03-21","2022-03-21","2022-12-02","2022-01-07","2022-01-07","2022-01-07","2022-08-03","2023-01-13","2023-02-01","2023-02-01","2022-03-31","2022-03-31"],"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":[["","69097081307","GABAPENTIN","CAP 100MG","270","Select","Select",""],["","00781285931","OMEPRAZOLE","CAP 10MG","60","Select","Select",""],["","68462010630","ONDANSETRON","TAB 8MG","9","Select","Select",""],["","62332025118","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","69494020024","NUTRASEB","","100","Select","Select",""],["","43598032675","CIPRO\/DEXA","SUS 0.3-0.1%","8","Select","Select",""],["","67877021905","CEPHALEXIN","500 MG","40","Select","Select",""],["","82607066026","FLOWFLEX","KIT TEST","8","Select","Select",""],["","00168008031","HYDROCORTISONE","2.5 %","30","Select","Select",""],["","00406055201","OXYCODONE HCL","5 MG","24","Select","Select",""],["","82607066026","FLOWFLEX COVID-","19 AG HOME TEST ","8","Select","Select",""],["","51672129802","KETOCONAZOLE","2 %","30","Select","Select",""],["","42571025101","CLINDAMYCIN HCL","150 MG","28","Select","Select",""],["","68462039530","OMEPRAZOLE CAP","10MG","60","Select","Select",""],["","69494020024","NUTRASEB CRE","","100","Select","Select",""],["","43598032675","CIPRO\/DEXA SUS","0.3-0.1%","8","Select","Select",""],["","68462010630","ONDANSETRON TAB","8MG","9","Select","Select",""],["","82607066026","FLOWFLEX KIT TEST","","8","Select","Select",""],["","68180012202","CEPHALEXIN CAP","500MG","40","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":""}]}]}