{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JADEN TOWLES","gend":0,"add":"103 ROYAL AMBERDEEN","city":"SMITHFIELD","state":"VA","zip":"23430-9998","dob":"2005-01-12","age":"","mstatus":"","insh":"2472607*01","cliId":"","pno":7578034211,"cno":7578034211,"email":"","ename":"","eno":"","pphy":"PASQUINELLI, LAWRENCE MD","ppno":7576686500,"pcpadd":"BLDG B 171 KEMPSVILLE RD,","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23502-9998","pcpcounty":"","pcpid":"","pcpname":"CMG - Children's Hospital of The King's Daughters - Tidewater Children's Associates","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7576686505,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F43.20","Q67.6","Z87.738","Z98.890","K56.7","Z87.768","F90.9","Z20.822","Z87.760","Z20.828","Z87.798","F41.9","F90.0","Z23."],"date":["2023-08-23","2023-04-20","2022-06-24","2023-01-06","2023-01-06","2023-01-06","2023-01-06","2023-01-06","2023-01-04","2022-09-26","2022-09-14","2023-09-06","2023-09-06","2023-09-06"],"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":[["","60505392701","GUANFACINE","TAB 1MG ER","30","Select","Select",""],["","45802041954","AMMONIUM LAC","LOT 0.12","225","Select","Select",""],["","10702010101","METHYLPHENID","TAB 10MG","30","Select","Select",""],["","10702010101","METHYLPHENIDATE HCL","10 MG","60","Select","Select",""],["","57237007530","ONDANSETRON HCL","4 MG","15","Select","Select",""],["","00904552952","HEARTBURN RELIEF","10 MG","28","Select","Select",""],["","60505392701","GUANFACINE HCL ER","1 MG","30","Select","Select",""],["","59651036105","IBUPROFEN","600 MG","112","Select","Select",""],["","00904699880","DOCUSATE SODIUM","100 MG","14","Select","Select",""],["","70010075405","METHOCARBAMOL","500 MG","42","Select","Select",""],["","57896010110","ACETAMINOPHEN","325 MG","56","Select","Select",""],["","00172392570","DIAZEPAM","2 MG","12","Select","Select",""],["","10702001850","OXYCODONE HCL","5 MG","28","Select","Select",""],["","51991096158","POLYETHYLENE GLYCOL","3350 17 G\/DOSE","238","Select","Select",""],["","60505392701","GUANFACINE TAB","1MG ER","30","Select","Select",""],["","10702010101","METHYLPHENID TAB","10MG","30","Select","Select",""],["","45802041954","AMMONIUM LAC LOT","12%","225","Select","Select",""],["","13668013501","ESCITALOPRAM OXALATE","5 MG","7","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":""}]}]}