{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"D  SEMAJLLESSUF ","gend":0,"add":"T52 3559TS YAB H","city":"NORFOLK","state":"VA","zip":"23518-9998","dob":"1966-05-30","age":"","mstatus":"","insh":"74000910*983","cliId":"","pno":"1675723055","cno":"","email":"","ename":"","eno":"","pphy":"ROSENBERG, DAVID MD","ppno":7573936363,"pcpadd":"664 LINCOLN STREET","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":"23704-9998","pcpcounty":"","pcpid":"","pcpname":"Hampton Roads Community Health Center","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","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":["L03.90","L02.93","L02.91","L03.113","Z20.822","Z87.891","Z96.642","R50.9","B18.2","Z87.438","N12.","R10.9","R30.0","R39.15","R35.0","R31.9","Z91.048","M79.89","L02.413","Z51.89","N45.3","N50.89","R60.9","N45.1","Z86.19","Z91.09","N50.812","R30.9","I09.89","N39.0","Z12.11","B20.","Z11.52","N20.0","N10.","K04.01","K08.89","T15.01XA","H16.141","H57.11","H25.13","J02.9","E87.1","N11.8","N30.90","E86.0","Z79.899","Z87.440","S61.219A","L02.419","A41.9","N30.00","H17.811","H04.123","F19.11","R00.0","L29.9","R19.7","N30.01","R65.21","L98.9","Z13.1","N50.819","A41.51","I47.2","K52.9","B96.20","D64.9","N28.89","Z09.","Z11.59","Z11.3","Z23.","G43.909","F15.10","Z03.89","R11.0","F11.20","F15.20","F14.20","F13.10","F90.9","F14.10","F11.10","F10.20","F12.20","F16.21","F43.10","F41.1","K04.90","F90.1","K21.9"],"date":["2021-09-18","2021-09-18","2022-05-31","2021-11-30","2021-11-30","2023-02-08","2022-08-15","2022-05-26","2022-05-27","2022-05-08","2022-06-02","2022-05-26","2022-07-18","2022-07-18","2022-07-18","2022-07-18","2022-09-26","2021-11-30","2021-12-05","2021-12-05","2022-05-26","2022-02-04","2022-02-04","2022-02-10","2023-02-08","2022-04-09","2022-02-10","2022-05-06","2022-05-07","2022-05-26","2022-05-28","2023-05-01","2021-11-30","2022-05-31","2022-06-01","2022-08-15","2022-08-15","2021-10-28","2021-11-12","2021-10-28","2021-11-12","2021-12-05","2022-05-27","2022-05-26","2022-05-26","2022-05-26","2022-10-28","2022-05-26","2021-10-07","2021-11-28","2022-05-26","2022-05-05","2021-11-12","2021-11-12","2022-05-27","2022-03-25","2022-04-09","2023-02-08","2022-05-27","2022-05-06","2021-11-12","2021-11-12","2022-02-04","2022-05-06","2022-05-06","2022-05-06","2022-05-06","2023-02-08","2022-12-07","2022-12-07","2022-10-28","2022-10-28","2022-11-15","2023-02-08","2023-04-03","2023-02-08","2023-02-08","2023-05-01","2023-05-01","2023-05-01","2023-04-17","2023-04-17","2023-04-03","2023-04-03","2023-05-01","2023-05-01","2023-05-01","2023-05-01","2023-05-01","2023-05-01","2023-05-01","2023-05-01"],"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":[["","68180012202","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","20","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","00234057508","HIBICLENS","LIQ 0.04","472","Select","Select",""],["","24208083060","NEO\/POLY\/DEX","SUS 0.1% OP","5","Select","Select",""],["","73473030060","CLINDAMYCIN","GEL 0.01","60","Select","Select",""],["","53489011905","DOXYCYCL HYC","CAP 100MG","14","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","16","Select","Select",""],["","68180065208","DOXYCYC MONO","CAP 100MG","14","Select","Select",""],["","68682010301","DICLOFENAC","TAB 100MG ER","30","Select","Select",""],["","42806016005","HYDROXYZ HCL","TAB 25MG","30","Select","Select",""],["","59651024701","MIDODRINE","TAB 5MG","60","Select","Select",""],["","31722072320","LEVOFLOXACIN","TAB 750MG","16","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","8","Select","Select",""],["","61958250101","BIKTARVY","50-200-25","30","Select","Select",""],["","00143122701","DICYCLOMINE HCL","20 MG","30","Select","Select",""],["","68180012202","CEPHALEXIN CAP","500MG","40","Select","Select",""],["","00093224001","CEPHALEXIN TAB","500MG","28","Select","Select",""],["","00234057508","HIBICLENS LIQ","4%","472","Select","Select",""],["","00093310905","AMOXICILLIN CAP","500MG","4","Select","Select",""],["","24208083060","NEO\/POLY\/DEX SUS","0.1% OP","5","Select","Select",""],["","65862042005","SMZ\/TMP DS TAB","800-160","20","Select","Select",""],["","73473030060","CLINDAMYCIN GEL","1%","60","Select","Select",""],["","00093226301","AMOXICILLIN TAB","500MG","21","Select","Select",""],["","53489011905","DOXYCYCL HYC CAP","100MG","14","Select","Select",""],["","42858010201","OXYCOD\/APAP TAB","5-325MG","16","Select","Select",""],["","68682010301","DICLOFENAC TAB","100MG ER","30","Select","Select",""],["","68180065208","DOXYCYC MONO CAP","100MG","14","Select","Select",""],["","42806016005","HYDROXYZ HCL TAB","25MG","30","Select","Select",""],["","59651024701","MIDODRINE TAB","5MG","180","Select","Select",""],["","31722072320","LEVOFLOXACIN TAB","750MG","16","Select","Select",""],["","53746010901","HYDROCO\/APAP TAB","5-325MG","8","Select","Select",""],["","61958250101","BIKTARVY TAB","","30","Select","Select",""],["","45802088830","OMEPRAZOLE","20 MG","28","Select","Select",""],["","00536340501","NICOTINE GUM","4 MG","100","Select","Select",""],["","49483008010","SENNA","8.6 MG","30","Select","Select",""],["","74300000300","DESITIN","13 %","57","Select","Select",""],["","00172572860","FAMOTIDINE","20 MG","5","Select","Select",""],["","00536430605","FIBER-LAX","625 MG","60","Select","Select",""],["","69097084615","CYCLOBENZAPRINE HCL","10 MG","15","Select","Select",""],["","49483034010","ACETAMINOPHEN","325 MG","20","Select","Select",""],["","62103032302","BOUDREAUXS","40 %","57","Select","Select",""],["","00093117410","PENICILLIN V POTASSIUM","500 MG","28","Select","Select",""],["","50111056101","TRAZODONE HCL","100 MG","30","Select","Select",""],["","00228212750","CLONIDINE HCL","0.1 MG","10","Select","Select",""],["","00378210001","LOPERAMIDE","2 MG","30","Select","Select",""],["","67877031905","IBUPROFEN","400 MG","100","Select","Select",""],["","45802005911","NYSTATIN","100000\/G","30","Select","Select",""],["","68462018135","CLOTRIMAZOLE","1 %","30","Select","Select",""],["","45802081184","NALOXONE HCL","4 MG","2","Select","Select",""],["","96295013836","ONE DAILY MULTIVITAMIN","400 MCG","30","Select","Select",""],["","00904719106","VITAMIN B-","1 100 MG","30","Select","Select",""],["","10135013201","THIAMINE HCL","100 MG","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":""}]}]}