{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  ATINREVYELTIHW L","gend":1,"add":"DRADNATS 102902 TPA NL ","city":"VIRGINIA BEACH","state":"VA","zip":23462,"dob":"1963-10-22","age":"","mstatus":"","insh":"37300210*71","cliId":"","pno":"57\/7579143-2","cno":"","email":"","ename":"","eno":"","pphy":"Route,  barbara","ppno":"757\/395-1900","pcpadd":"5424 Discovery Park Blvd BLDB A STE 201","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":"","pcpname":"Hampton Roads Community Health Center","plan":"OHP","program":"Medicaid","lob":"OHCC","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":["F25.0","E11.40","E11.65","M79.605","L21.9","L81.8","Z71.9","B35.1","R92.1","M25.511","M54.17","M65.332","I10.","E78.5","Z12.31","NO DATA","M79.644","Z01.419","Z12.11","J10.1","Z87.891","R06.02","S40.011A","Z86.39","Y09.","Z23.","E66.01","M51.36","M47.816","Z12.39","M79.662","J02.0","R93.7","J06.9","R05.","E11.51","L84.","M21.611","M21.612","Z11.59","Z11.4","Z79.84","F10.10","F33.0","M54.9","M89.8X9","F31.9","G89.29","K13.79","Z11.3","Z86.010"],"date":["2022-02-13","2022-11-09","2022-11-09","2020-10-12","2020-12-11","2020-12-11","2020-12-11","2022-11-09","2020-08-12","2020-08-27","2021-08-18","2021-04-12","2022-08-24","2022-08-17","2022-03-21","2022-04-11","2020-06-29","2021-04-23","2021-04-23","2020-03-08","2021-05-27","2020-03-08","2020-08-25","2020-08-25","2020-08-25","2021-09-13","2022-03-21","2021-08-18","2021-08-18","2021-04-23","2021-05-05","2021-05-27","2021-09-13","2020-02-17","2020-02-17","2020-05-28","2020-05-28","2020-05-28","2020-05-28","2022-03-21","2022-03-21","2022-08-17","2022-08-17","2022-07-10","2022-08-24","2022-08-24","2022-08-24","2022-04-11","2022-07-22","2022-07-22","2022-11-22"],"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":[["","00378718705","METFORMIN","TAB 1000MG","180","Select","Select",""],["","69452014430","BENZONATATE","CAP 200MG","30","Select","Select",""],["","00054429731","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","43547034150","RISPERIDONE","TAB 1MG","30","Select","Select",""],["","51672400401","NORTRIPTYLIN","CAP 75MG","30","Select","Select",""],["","55111032101","GLIMEPIRIDE","TAB 2MG","30","Select","Select",""],["","55111012105","ATORVASTATIN","TAB 10MG","30","Select","Select",""],["","68180097903","LISINOPRIL","TAB 40MG","90","Select","Select",""],["","60505015701","BUPROPION","TAB 100MG","90","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","58657050004","CODEINE\/GG","SOL 10-100\/5","120","Select","Select",""],["","00121077504","GG\/CODEINE","SOL 100-10\/5","120","Select","Select",""],["","80777027310","MODERNA","INJ COVID-19","0","Select","Select",""],["","65162010150","GABAPENTIN","CAP 100MG","270","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","00904698640","MUCUS","TAB 600MG ER","60","Select","Select",""],["","00781106110","ALPRAZOLAM","TAB 0.25MG","60","Select","Select",""],["","11877001140","BINAXNOW","KIT HOME TES","8","Select","Select",""],["","00406117003","NALTREXONE","TAB 50MG","14","Select","Select",""],["","00363032706","GENTLE","TAB 5MG EC","4","Select","Select",""],["","68645019059","METOPROL","TAB 50MG","60","Select","Select",""],["","43386009019","GAVILYTE-G","SOL ","4000","Select","Select",""],["","81421002001","DULCOLAX","TAB 5MG EC","4","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00093077198","PRAVASTATIN","TAB 10MG","30","Select","Select",""],["","00168014630","HYDROCORT","OIN 0.025","28","Select","Select",""],["","45802046564","KETOCONAZOLE","SHA 0.02","120","Select","Select",""],["","00006027731","JANUVIA","TAB 100MG","90","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","20","Select","Select",""],["","00310653004","BYDUREON","INJ 2MG","4","Select","Select",""],["","53885039310","ONETOUCH","MIS LANCETS","100","Select","Select",""],["","65702072310","ACCU-CHEK","KIT AVIVA PL","1","Select","Select",""],["","51672401801","ETODOLAC","TAB 400MG","180","Select","Select",""],["","99073070805","FREESTYLE    MIS LITE","MIS LITE","1","Select","Select",""],["","08484070120","PRODIGY","KIT MONITOR","1","Select","Select",""],["","00193725201","CONTOUR","KIT NEXT EZ","1","Select","Select",""],["","33342005610","PIOGLITAZONE","TAB 45MG","90","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","52268001201","SUPREP","SOL PREP KIT","354","Select","Select",""],["","43386006019","GAVILYTE-C","SOL ","4000","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","68180046403","SIMVASTATIN","TAB 40MG","26","Select","Select",""],["","69543025216","VIRTUSSIN","SOL 100-10\/5","120","Select","Select",""],["","16714081901","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","62542030117","HYD","SUS 10-8\/5ML","120","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}