{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" REHPOTSIRHCPURHTRON T ","gend":0,"add":"ERAWALED 5113J TPA EVA ","city":"NORFOLK","state":"VA","zip":23504,"dob":"1973-01-14","age":"","mstatus":"","insh":"0917110*09","cliId":"","pno":"23\/7438966-4","cno":"347\/324-6698","email":"","ename":"","eno":"","pphy":"Route,  barbara","ppno":"804\/633-5840","pcpadd":"5424 Discovery Park Blvd BLDB A STE 201","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23504,"pcpcounty":"","pcpid":"","pcpname":"Hampton Roads Community Health Center","plan":"OHP","program":"ACA","lob":"Individual","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":["M79.10","D72.819","R07.9","I10.","E11.9","Z21.","Z82.49","R07.2","M50.321","M50.322","M50.323","M54.50","F32.A","F41.1","M51.26","M51.34","M79.671","Z20.822","E11.42","M54.31","E86.0","E78.5","Z79.899","R53.81","M54.6","G62.9","M51.16","M47.816","Z91.14","F41.9","R20.0","R07.89","M54.12","M50.90","R00.0","G47.00","M25.519","F33.9","F41.8","M54.41","M47.812","M99.71","M54.17","M89.8X1","M54.16"],"date":["2022-02-10","2022-02-10","2022-02-19","2022-02-27","2021-09-02","2022-02-27","2021-09-02","2021-09-02","2022-02-04","2022-02-04","2022-02-04","2022-02-04","2022-03-22","2022-03-22","2022-02-27","2022-02-27","2022-02-27","2021-01-10","2022-02-19","2022-02-19","2022-02-19","2022-02-19","2022-02-19","2022-02-19","2022-03-04","2022-02-27","2022-02-27","2022-02-27","2022-02-27","2022-02-27","2022-02-27","2021-09-02","2022-02-21","2022-02-21","2022-02-21","2022-02-21","2022-02-21","2021-06-29","2021-06-29","2022-02-19","2022-02-21","2022-02-21","2022-03-04","2022-03-04","2022-03-01"],"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":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","68180072003","AMLODIPINE","TAB 5MG","-90","Select","Select",""],["","49702023113","TRIUMEQ","TAB ","30","Select","Select",""],["","27241009903","DULOXETINE","CAP 60MG","60","Select","Select",""],["","55111012105","ATORVASTATIN","TAB 10MG","-30","Select","Select",""],["","31722070010","LOSARTAN","TAB 25MG","30","Select","Select",""],["","00378427577","VALACYCLOVIR","TAB 500MG","4","Select","Select",""],["","23155013525","DOXYCYC","TAB 100MG","30","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","56151146001","TRUE","TES GLUCOSE","100","Select","Select",""],["","70010006305","METFORMIN","TAB 500MG","-60","Select","Select",""],["","16571078001","CARISOPRODOL","TAB 250MG","15","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","43547028910","BUPROPION","TAB 150MG SR","30","Select","Select",""],["","47469016068","MELATONIN","TAB 3MG","90","Select","Select",""],["","65162010250","GABAPENTIN","CAP 300MG","180","Select","Select",""],["","75834002012","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","00115180301","HYDROXYZ","CAP 25MG","-60","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","00093005301","BUSPIRONE","TAB 5MG","60","Select","Select",""],["","70954005940","PREDNISONE","PAK 10MG","48","Select","Select",""],["","55111032201","GLIMEPIRIDE","TAB 4MG","30","Select","Select",""],["","50924097110","SOFTCLIX","MIS LANCETS","100","Select","Select",""],["","53885004601","ONETOUCH","KIT ULTRA 2","1","Select","Select",""],["","60793070204","BICILLIN","INJ 2400000","8","Select","Select",""],["","00713050324","ANUCORT-HC","SUP 25MG","30","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","30","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","11917015018","LANCET","MIS THIN 30G","200","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":""}]}]}