{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ELISA ORTIZ ARELLANO","gend":1,"add":"833 HAYES ST","city":"NORFOLK","state":"VA","zip":"23504-9998","dob":"1985-12-04","age":"","mstatus":"","insh":"2466698*01","cliId":"","pno":7576852776,"cno":7576852776,"email":"","ename":"","eno":"","pphy":"MARKOVIC, VLADIMIR MD","ppno":7575339108,"pcpadd":"155 KINGSLEY LANE SUITE 320,","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23505-9998","pcpcounty":"","pcpid":"","pcpname":"Hampton Roads Community Health Center","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7576226384,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B34.9","J02.9","D68.61","D84.9","Z90.81","Z86.718","Z20.822","Z79.01","D69.3","N60.82","Z13.71","R10.11","B35.3","Z00.00","Q89.01","E55.9","I82.402","M79.605","H81.10","R51.9","R53.83","R53.81","K76.0","N60.99","Z00.01","R73.02","E78.2","R79.89","D50.8","Z98.890"],"date":["2022-09-23","2022-09-23","2022-09-23","2022-09-23","2022-09-23","2023-02-16","2022-09-23","2023-02-16","2023-01-23","2023-06-01","2023-01-23","2022-06-01","2022-05-20","2022-10-26","2022-10-26","2022-12-07","2022-12-07","2022-12-07","2023-02-16","2023-02-16","2023-02-16","2023-02-16","2022-06-01","2022-09-22","2022-08-15","2022-08-15","2022-08-15","2022-08-15","2023-06-29","2023-06-01"],"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":[["","51672208002","TERBINAFINE","CRE 0.01","30","Select","Select",""],["","57237012101","WARFARIN","TAB 2.5MG","38","Select","Select",""],["","49035013606","EQ LIDOCAINE","PAD 0.04","20","Select","Select",""],["","62332042631","BENZONATATE","CAP 100MG","30","Select","Select",""],["","69452015120","VITAMIN D","2 1250 MCG","12","Select","Select",""],["","57237012101","WARFARIN SODIUM","2.5 MG","38","Select","Select",""],["","59746012206","MECLIZINE HCL","12.5 MG","60","Select","Select",""],["","51672208002","TERBINAFINE CRE","1%","30","Select","Select",""],["","57237012101","WARFARIN TAB","2.5MG","38","Select","Select",""],["","49035013606","EQ LIDOCAINE PAD","4%","20","Select","Select",""],["","62332042631","BENZONATATE CAP","100MG","30","Select","Select",""],["","69452015120","VITAMIN D CAP","50000UNT","12","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":""}]}]}