{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TRAVIS SMALLEGAN","gend":0,"add":"208 73RD ST APT B","city":"VIRGINIA BEACH","state":"VA","zip":"23451-9998","dob":"2001-11-21","age":"","mstatus":"","insh":"8221723*01","cliId":"","pno":7573627194,"cno":7573627194,"email":"","ename":"","eno":"","pphy":"WRUBEL, CHRISTOPHER J MD","ppno":7573337797,"pcpadd":"1181 FIRST COLONIAL ROAD STE 100,","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23454-9998","pcpcounty":"","pcpid":"","pcpname":"CMG - Children's Hospital of The King's Daughters - Premier Pediatrics","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7573337760,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["V58.89","G82.50","R26.9","R20.2","F11.20","Z11.52","F33.1","F33.2","V62.84","F12.20","Z01.89","Z91.09","Z13.30","F98.8","F11.23","Z91.51","Z62.810","S14.109A","R53.83","R29.898","W19.XXXA","Z76.89","F90.9","Z13.89","Z51.81","F43.10","F33.9","R15.9","R32.","N30.00","R10.30","T40.2X1A","T40.411A","M62.81","Z20.822","F34.81","F91.2","F95.2","F10.20","F43.22","Z04.9","F41.1","Z87.828","Z91.81","F13.239","F15.20","F17.210","Z59.00","T50.901A","F11.90"],"date":["2021-08-20","2021-02-08","2021-02-08","2021-02-08","2023-03-10","2021-08-19","2022-08-23","2022-02-15","2021-07-08","2023-03-10","2021-07-10","2021-07-10","2021-02-11","2021-02-11","2022-02-15","2022-01-13","2022-01-13","2022-02-15","2022-02-15","2021-08-20","2021-02-08","2021-02-11","2021-02-11","2021-03-31","2021-03-31","2022-07-19","2022-07-19","2023-02-02","2023-02-02","2021-05-28","2021-05-28","2023-02-19","2023-02-19","2021-02-04","2021-02-04","2021-02-12","2021-02-12","2021-02-12","2023-03-10","2021-05-03","2021-02-11","2021-07-14","2021-08-20","2021-08-20","2022-02-15","2022-02-15","2022-02-15","2022-02-15","2023-05-05","2023-05-05"],"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":[["","00093005301","BUSPIRONE","TAB 5MG","28","Select","Select",""],["","12496120803","SUBOXONE","8 MG-2 MG","1","Select","Select",""],["","47781035703","BUPREN\/NALOX","MIS 8-2MG","28","Select","Select",""],["","00378210001","LOPERAMIDE","CAP 2MG","30","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","50111056101","TRAZODONE","TAB 100MG","7","Select","Select",""],["","00536247085","MILK OF MAGN","SUS ","473","Select","Select",""],["","80681008500","MELATONIN","3 MG","30","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","00185061501","HYDROXYZ PAM","CAP 50MG","56","Select","Select",""],["","49483034010","ACETAMIN","TAB 325MG","30","Select","Select",""],["","49348092710","SM IBUPROFEN","TAB 200MG","30","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","16729014601","QUETIAPINE","TAB 50MG","14","Select","Select",""],["","00904699446","GAS RELIEF","CAP 125MG","30","Select","Select",""],["","00904723760","BANOPHEN","25 MG","2","Select","Select",""],["","69238111801","BUSPIRONE HCL","15 MG","60","Select","Select",""],["","50111056101","TRAZODONE HCL","100 MG","30","Select","Select",""],["","68180012202","CEPHALEXIN","500 MG","30","Select","Select",""],["","46122035374","NICOTINE PATCH","21 MG\/24HR","7","Select","Select",""],["","65862001105","SERTRALINE HCL","25 MG","30","Select","Select",""],["","45802091987","CETIRIZINE HCL","10 MG","30","Select","Select",""],["","00115180401","HYDROXYZINE PAMOATE","50 MG","30","Select","Select",""],["","12496120803","SUBOXONE MIS","8-2MG","28","Select","Select",""],["","47781035703","BUPREN\/NALOX MIS","8-2MG","28","Select","Select",""],["","00185061501","HYDROXYZ PAM CAP","50MG","56","Select","Select",""],["","64380080807","IBUPROFEN TAB","600MG","30","Select","Select",""],["","00378210001","LOPERAMIDE CAP","2MG","30","Select","Select",""],["","57237007710","ONDANSETRON TAB","4MG ODT","10","Select","Select",""],["","50111056101","TRAZODONE TAB","100MG","7","Select","Select",""],["","00536247085","MILK OF MAGN SUS","","473","Select","Select",""],["","80681008600","MELATONIN TAB","3MG","30","Select","Select",""],["","00904699446","GAS RELIEF CAP","125MG","30","Select","Select",""],["","00172572860","FAMOTIDINE TAB","20MG","30","Select","Select",""],["","16729014601","QUETIAPINE TAB","50MG","14","Select","Select",""],["","00093005301","BUSPIRONE TAB","5MG","28","Select","Select",""],["","49483034010","ACETAMIN TAB","325MG","30","Select","Select",""],["","49348092710","SM IBUPROFEN TAB","200MG","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":""}]}]}