{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LEA  S GOODWIN","gend":1,"add":"1002 FLORIDA ST RM 106","city":"HAMPTON","state":"VA","zip":"23669-9998","dob":"1981-01-07","age":"","mstatus":"","insh":"7928548*01","cliId":"","pno":"757\/975-9677","cno":"757\/975-9677","email":"","ename":"","eno":"","pphy":"FRISCO, SHAWNITA A MD","ppno":"757\/827-2025","pcpadd":"4001 COLISEUM DR STE 300","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":119880,"pcpname":"SMG - Sentara Family & Internal Medicine Physicians - CarePlex West","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.411","Z30.09","N92.0","R10.31","N94.5","D25.9","B20.","F41.8","F19.129","Z68.41","Z71.6","N39.498","F33.1","R87.613","M25.562","M79.89","S61.210A","F43.20","E66.01","R13.10","Z98.84","Z68.42","K21.9","F17.200","J00.","R42.","H65.03","R09.82","G44.89","E55.9","Z68.43","K85.90","R10.13","R10.9","N93.9","R51.","Z21.","Z71.7","R73.03","F17.210","R60.0","H35.363","H04.123","NO DATA","H18.413","R87.810","Z32.02","Z79.899","Z28.21","K02.9","K08.89","G44.52","R06.00","E16.2","Z00.00","Z01.818","R68.89","K90.9","H93.293","M94.0","G44.229","R07.89","S61.412A","N39.0","H93.11","H69.81","G47.33","R06.83","F32.9","Z79.1","Z88.0","M79.644","Z01.810","Z01.812","Z20.822","H00.015","H57.12","Z09.","Z48.02","E11.9","E11.69","Z87.891","E75.6","G89.29","F41.9","F14.20","F17.209"],"date":["2020-02-27","2021-08-03","2021-08-03","2021-08-03","2021-08-03","2021-08-03","2021-08-03","2021-08-03","2020-10-27","2021-04-22","2021-08-03","2021-08-03","2020-09-16","2021-08-03","2021-08-11","2020-08-26","2021-01-15","2021-03-26","2021-05-20","2021-04-20","2021-04-20","2021-05-20","2021-05-20","2021-05-20","2020-01-18","2020-12-14","2021-06-08","2021-06-08","2020-11-25","2021-06-08","2021-08-03","2021-06-08","2021-06-01","2021-06-06","2021-07-21","2020-05-06","2021-08-11","2020-10-28","2021-03-26","2021-03-26","2020-12-14","2021-05-04","2021-05-04","2021-05-04","2021-05-04","2021-05-18","2021-05-18","2021-08-11","2020-04-01","2021-01-02","2020-10-10","2021-01-06","2020-06-06","2020-07-03","2020-08-25","2020-10-27","2020-10-27","2020-10-27","2021-01-05","2020-08-16","2020-08-16","2020-08-16","2020-09-28","2020-11-06","2020-12-10","2020-12-10","2020-12-10","2020-12-10","2021-08-17","2021-01-15","2021-01-15","2021-01-15","2021-07-17","2021-07-17","2021-07-17","2020-03-08","2020-03-08","2021-06-08","2021-01-28","2021-08-11","2021-08-11","2021-08-11","2021-08-11","2021-08-11","2021-08-17","2021-08-17","2021-08-17"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","61958250101","BIKTARVY ","","30","Select","Select",""],["","00574402435","ERYTHROMYCIN ","5MG\/GM","4","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","30","Select","Select",""],["","64380080807","IBUPROFEN ","600MG","90","Select","Select",""],["","59746012106","MECLIZINE ","25MG","30","Select","Select",""],["","75834002012","VITAMIN ","50000UNT","4","Select","Select",""],["","51672400101","NORTRIPTYLIN ","10MG","30","Select","Select",""],["","65862018601","CLINDAMYCIN ","300MG","21","Select","Select",""],["","31722072690","MONTELUKAST ","10MG","30","Select","Select",""],["","57237002801","AMOXICILLIN ","500MG","21","Select","Select",""],["","00378427577","VALACYCLOVIR ","500MG","60","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","8","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","16","Select","Select",""],["","43598081115","CETIRIZINE ","10MG","30","Select","Select",""],["","00185012201","NITROFURANTN ","100MG","14","Select","Select",""],["","51224012230","AZITHROMYCIN ","500MG","20","Select","Select",""],["","00378047705","DIAZEPAM ","10MG","1","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","14","Select","Select",""],["","10702000350","PROMETHAZINE ","25MG","30","Select","Select",""],["","55111012105","ATORVASTATIN ","10MG","30","Select","Select",""],["","51079030630","POLYETH ","3350 NF","30","Select","Select",""],["","59762500801","MISOPROSTOL ","200MCG","2","Select","Select",""],["","00093031401","KETOROLAC ","10MG","10","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}