{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" A   YKCIRRS SIRRAH","gend":0,"add":"EFEEKO 705101 TPA TS ","city":"NORFOLK","state":"VA","zip":"23504-9998","dob":"1961-01-03","age":"","mstatus":"","insh":"7812210*98","cliId":"","pno":"13\/7575980-8","cno":"757\/318-0895","email":"","ename":"","eno":"","pphy":"ROSENBERG, DAVID MD","ppno":"757\/393-6363","pcpadd":"664 LINCOLN STREET","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":23704,"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":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G89.18","I10.","Z98.890","R09.81","J34.89","Z09.","Z68.31","I73.9","M25.511","K29.60","M54.5","M79.604","M79.605","M54.16","NO DATA","Z68.29","M54.42","M54.41","G89.29","M65.332","S63.92XA","B19.20","K59.09","R14.0","Z86.010","K40.90","N20.0","M20.21","M20.22","M79.671","M79.674","R26.2","Z48.89","R05.","Z68.30","J01.00","K08.89","Z76.0","Z01.818","Z11.59","Z86.19","M20.5X1","M79.645","M79.606","K59.00","R14.3","E66.8","R94.31","I44.0","I73.89","J32.9","J34.2","J34.3","J35.2","Z01.810","B18.2","K76.0","R06.02","K29.70","K44.9","R10.9","R11.10","Z87.891","K21.9","Z20.822","Z23.","G25.81","N20.1","N13.30","N13.4","L70.0","Z71.9","J32.0","H25.13","H40.013","H04.123","M15.2"],"date":["2021-01-28","2022-09-09","2022-04-06","2021-06-12","2021-02-14","2021-06-14","2022-03-30","2022-06-23","2021-07-07","2022-03-30","2021-08-27","2022-10-26","2022-10-26","2021-08-27","2022-10-26","2021-09-30","2022-10-26","2022-10-26","2022-10-26","2022-05-06","2022-05-06","2020-08-07","2020-10-30","2022-03-30","2021-03-22","2022-07-22","2020-06-07","2020-09-24","2020-09-15","2020-08-05","2020-10-22","2020-10-22","2021-06-17","2021-06-12","2022-04-06","2020-02-11","2020-03-23","2022-09-09","2022-01-27","2020-09-09","2021-03-22","2020-09-24","2021-06-28","2022-10-26","2022-03-30","2022-03-30","2022-03-30","2022-01-27","2020-09-10","2020-09-15","2021-01-26","2021-01-26","2021-01-26","2021-01-26","2022-01-27","2022-06-03","2020-09-14","2020-05-18","2020-09-11","2020-09-11","2020-10-30","2020-10-30","2021-03-10","2021-03-10","2022-01-27","2020-09-14","2022-09-09","2020-01-31","2020-01-31","2020-01-31","2021-01-20","2021-01-20","2021-01-27","2021-07-09","2021-07-09","2021-07-09","2022-08-19"],"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":[["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","57237000201","HYDROCHLOROT","CAP 12.5MG","30","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","90","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","90","Select","Select",""],["","57896065809","ALLERGY","TAB 10MG","30","Select","Select",""],["","68180051901","LISINOP\/HCTZ","TAB 20-12.5","30","Select","Select",""],["","29300024310","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","30","Select","Select",""],["","00603020922","MAG","TAB 400MG","30","Select","Select",""],["","62559051101","INDAPAMIDE","TAB 2.5MG","30","Select","Select",""],["","13668009490","PRAMIPEXOLE","TAB 1MG","90","Select","Select",""],["","00093645156","ESOMEPRA","CAP 40MG DR","30","Select","Select",""],["","00591079410","DICYCLOMINE","CAP 10MG","120","Select","Select",""],["","68462039790","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","47781019601","OXYCOD\/APAP","TAB 5-325MG","24","Select","Select",""],["","42806054701","VITAMIN","CAP 1.25MG","4","Select","Select",""],["","70461032203","FLUCLVX","INJ 2022-23","0","Select","Select",""],["","59267030402","PFIZER","INJ BA4\/BA5","0","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","43547038011","DULOXETINE","CAP 30MG","30","Select","Select",""],["","50383077504","LIDOCAINE","SOL 2% VISC","1","Select","Select",""],["","62135098550","DOXYCYCL","CAP 100MG","120","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","05928000308","SINUS","POW BTLE KIT","5","Select","Select",""],["","00536250676","SALINE","SPR 0.0065","44","Select","Select",""],["","70000000101","NASAL","SPR 0.0005","30","Select","Select",""],["","68180012201","CEPHALEXIN","CAP 500MG","9","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","10","Select","Select",""],["","69452014320","BENZONATATE","CAP 100MG","10","Select","Select",""],["","49483060550","GABAPENTIN","CAP 100MG","30","Select","Select",""],["","58160088752","FLUARIX","INJ 2021-22","0","Select","Select",""],["","58602070653","FAMOTIDINE","TAB 20MG","15","Select","Select",""],["","64764024060","AMITIZA","CAP 24MCG","60","Select","Select",""],["","00904578017","HEARTBURN","TAB 20MG","15","Select","Select",""],["","57237001401","TAMSULOSIN","CAP 0.4MG","14","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00074262528","MAVYRET","TAB 100-40MG","84","Select","Select",""],["","57237003101","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","00093819201","CIMETIDINE","TAB 300MG","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":""}]}]}