{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DONNISHA T GOODMAN","gend":1,"add":"107 FOUNDER WAY APT 201","city":"PORTSMOUTH","state":"VA","zip":"23707-9998","dob":"1997-06-20","age":"","mstatus":"","insh":"6050360*01","cliId":"","pno":7575606773,"cno":7575606773,"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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H57.11","U07.1","V87.7XXA","S06.9X9A","I60.9","Z20.2","Z30.42","R07.89","N89.8","R11.10","Z01.89","M25.551","M54.9","F41.9","R10.31","R41.0","A74.9","A54.9","B00.9","J34.89","R43.2","M25.569","T14.90XA","R69.","N92.1","S82.202A","S82.402A","G40.209","N30.00","R07.9","K29.90","Z30.9","S82.209A","Z32.02","F39.","J80.","R07.81","R05.9","N76.0","N64.4","R10.11","R06.02","F90.9","F31.9","Z91.018","R10.9","R10.10","R93.3","K59.00","Z98.890","G44.209","R51.9","K08.89","K04.7","Z01.419","Z11.3","Z30.09","Z71.85","N92.6","N39.0","B37.3","G89.29","R10.2","Z53.29","R79.89","R00.0","Z86.16","NO DATA","R10.84","Z78.9","B96.89","Z87.891","Z20.822","Z79.899","O26.891","R58.","R09.02","R61.","O99.611","Z3A.09","R10.30","R06.89","O20.0","A59.9","Z3A.12","O23.592","A59.01","Z3A.00"],"date":["2021-03-02","2021-03-03","2022-02-21","2021-03-03","2021-03-03","2023-02-19","2021-09-10","2022-10-09","2022-08-19","2022-02-11","2022-02-11","2022-02-21","2022-02-21","2022-02-21","2022-10-09","2022-10-19","2021-01-05","2021-01-05","2021-01-05","2021-02-26","2021-02-19","2021-03-02","2021-03-02","2021-03-02","2021-03-19","2022-05-10","2022-05-10","2022-04-26","2022-04-26","2022-03-13","2022-03-15","2022-03-15","2022-03-15","2022-10-26","2022-09-08","2022-03-13","2022-03-13","2022-03-13","2023-06-04","2022-08-03","2022-10-09","2022-10-09","2022-10-19","2022-10-19","2022-10-19","2023-06-27","2022-10-14","2022-10-19","2023-06-27","2022-10-19","2022-04-26","2022-04-26","2022-07-18","2022-07-18","2022-10-26","2022-10-26","2022-10-26","2022-10-26","2021-03-19","2023-07-08","2022-08-19","2022-09-13","2022-12-06","2021-09-28","2021-09-28","2021-09-28","2021-09-28","2022-10-19","2023-07-08","2021-06-11","2022-08-03","2022-08-03","2022-10-19","2022-10-19","2023-06-04","2023-07-08","2023-07-08","2023-07-08","2023-06-27","2023-06-27","2023-06-27","2023-06-27","2023-07-08","2023-07-08","2023-06-27","2023-08-07","2023-08-07","2023-08-07"],"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":[["","55111014512","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","69238110002","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","68645056354","IBUPROFEN","TAB 800MG","20","Select","Select",""],["","70700015010","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","00548540000","MEDROXYPR AC","INJ 150MG\/ML","1","Select","Select",""],["","65162010211","GABAPENTIN","CAP 300MG","60","Select","Select",""],["","70710112307","DOXYCYC MONO","TAB 100MG","14","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","30","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","28","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","16714048301","CLINDAMYCIN","SOL 75MG\/5ML","800","Select","Select",""],["","66689002316","HYDROCO\/APAP","SOL 7.5-325","180","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","11523077101","GYNE-LOTRIMI","CRE 3","21","Select","Select",""],["","51672206200","3 DAY VAGINL","CRE 0.02","21","Select","Select",""],["","70700012487","LOJAIMIESS","TAB ","91","Select","Select",""],["","00143122701","DICYCLOMINE","TAB 20MG","30","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","30","Select","Select",""],["","55111014512","FLUCONAZOLE TAB","150MG","2","Select","Select",""],["","69238110002","DOXYCYCL HYC CAP","100MG","20","Select","Select",""],["","31722094901","OXYCOD\/APAP TAB","5-325MG","12","Select","Select",""],["","68645056354","IBUPROFEN TAB","800MG","20","Select","Select",""],["","68462015713","ONDANSETRON TAB","4MG ODT","30","Select","Select",""],["","65162010211","GABAPENTIN CAP","300MG","60","Select","Select",""],["","70710112307","DOXYCYC MONO TAB","100MG","14","Select","Select",""],["","00548540000","MEDROXYPR AC INJ","150MG\/ML","1","Select","Select",""],["","70700015010","OMEPRAZOLE CAP","20MG","60","Select","Select",""],["","67877021905","CEPHALEXIN CAP","500MG","14","Select","Select",""],["","66689002316","HYDROCO\/APAP SOL","7.5-325","180","Select","Select",""],["","63304069301","CLINDAMYCIN CAP","300MG","30","Select","Select",""],["","16714048301","CLINDAMYCIN SOL","75MG\/5ML","800","Select","Select",""],["","50111033402","METRONIDAZOL TAB","500MG","14","Select","Select",""],["","11523077101","GYNE-LOTRIMI CRE","3","21","Select","Select",""],["","49035091530","OMEPRAZOLE TAB","20MG","30","Select","Select",""],["","00143122701","DICYCLOMINE TAB","20MG","30","Select","Select",""],["","70700012487","LOJAIMIESS TAB","","91","Select","Select",""],["","63304061650","DOXYCYC MONO CAP","100MG","14","Select","Select",""],["","16571020150","DICLOFENAC TAB","75MG DR","30","Select","Select",""],["","42806031250","DOXYCYCL HYC TAB","100MG","14","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":""}]}]}