{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROGER D HELMS","gend":0,"add":"1303 CALLA AVE","city":"NORFOLK","state":"VA","zip":"23503-9998","dob":"1955-01-28","age":"","mstatus":"","insh":"900036062*01","cliId":"","pno":"757\/943-4026","cno":"","email":"","ename":"","eno":"","pphy":"MARKOVIC, VLADIMIR MD","ppno":"757\/393-6363","pcpadd":"3415 GRANBY STREET","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23504,"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":"757\/397-0047","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S39.012A","G60.9","J43.2","M51.36","M51.26","E11.40","M54.2","M50.30","Z79.899","M54.5","K74.60","E11.9","R10.9","J44.9","K29.61","D61.818","K76.6","R18.8","E72.20","K57.31","I85.10","K92.1","J43.9","Z99.3","R27.0","K31.7","R16.1","I10.","Z20.828","E78.5","K92.2","K57.90","D50.9","Z79.1","Z11.52","K62.5","J44.1","K65.2","K74.69","E11.43","K75.81","R55.","K59.00","E11.65","G47.33","G89.29","E66.9","Z68.32","Z86.73","I51.7","K83.8","N20.0","L03.116","D70.9","Z01.812","Z20.822","K64.8","K63.5","K57.30","Z11.4","E08.40","Z79.4","R10.31","Z71.3","D69.6","Z87.891","R10.32","G93.40","R73.9","K72.90","R42.","R60.9","E13.9","Z68.33","G62.9","K76.9","M54.16","R09.89","R06.02","Z53.21","R11.0","I86.8","K64.4","K62.89","K37.","E11.42","G47.30","Z90.49","N48.1","R11.2","E87.1","E87.6","R13.10","K31.89","D84.9","Z80.9","Z88.5","Z88.8","K70.30","L29.9","N28.1","J30.2","R10.84","G44.89","M54.9","I12.9","E11.22","R00.0","Z79.51","Z86.010","R53.83","G47.10","Z72.820","J98.8","Z74.3","B35.9","L72.9","Z68.35","R07.89","R07.9","E03.9","G60.3","M79.662","M79.605","B37.2","R21.","N52.9","M25.511","M25.551","R07.81","I85.00","R26.0","D12.0"],"date":["2019-09-12","2019-12-04","2021-03-29","2021-09-09","2021-09-09","2021-09-09","2021-09-09","2021-09-09","2021-09-15","2021-09-09","2021-07-20","2021-11-15","2021-03-29","2021-10-12","2020-11-02","2021-07-08","2021-07-10","2021-04-01","2020-10-26","2020-10-26","2020-10-26","2020-10-26","2021-10-04","2020-10-26","2020-10-26","2020-10-29","2020-10-26","2021-10-12","2020-10-26","2021-08-03","2020-11-18","2020-10-29","2021-07-08","2020-11-18","2021-01-27","2021-09-17","2021-03-17","2021-03-29","2021-09-15","2021-03-29","2021-03-29","2021-04-01","2021-03-29","2021-03-29","2021-12-07","2021-07-08","2021-03-29","2021-03-29","2021-09-15","2021-04-01","2021-07-08","2021-07-08","2021-07-10","2021-07-10","2021-09-13","2021-09-13","2021-09-15","2021-09-15","2021-09-15","2019-12-04","2019-12-04","2021-09-15","2020-10-05","2020-04-10","2020-10-30","2021-10-04","2020-10-26","2021-03-31","2021-04-01","2021-04-01","2021-04-05","2021-08-31","2021-08-31","2021-08-31","2019-10-28","2021-07-20","2020-02-03","2021-08-19","2021-08-19","2021-08-19","2021-08-26","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-10-04","2021-10-04","2021-09-15","2021-11-15","2020-05-06","2020-05-06","2020-05-06","2021-05-07","2020-10-29","2021-07-08","2021-07-08","2021-10-04","2021-10-04","2021-07-08","2021-10-04","2020-10-12","2020-03-23","2020-10-29","2020-11-19","2021-04-14","2021-08-03","2021-08-03","2020-05-06","2020-05-06","2020-05-06","2020-05-06","2020-05-18","2020-10-02","2021-08-19","2021-08-19","2021-10-12","2021-10-12","2019-09-23","2020-02-15","2020-02-15","2020-10-30","2021-01-12","2021-07-08","2021-07-20","2021-10-04","2021-10-04","2020-02-03","2020-04-01","2020-04-01","2020-04-01","2020-10-12","2021-01-12","2021-09-15"],"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":[]}]},{"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":[["","00093317431","ALBUTEROL SULFATE HFA ","HFA","26","Select","Select",""],["","00487020103","IPRATROPIUM BROMIDE\/ALBUTEROL SULFATE ","ALBUTER","360","Select","Select",""],["","00169643810","LEVEMIR FLEXTOUCH ","FLEXTOUC","15","Select","Select",""],["","59746021605","SPIRONOLACTONE ","25MG","30","Select","Select",""],["","59310057922","PROAIR HFA ","","26","Select","Select",""],["","68645051054","HYDROCHLOROTHIAZIDE ","25MG","90","Select","Select",""],["","00168000215","TRIAMCINOLONE ACETONIDE ","0.50%","-15","Select","Select",""],["","31722070930","SILDENAFIL ","25MG","30","Select","Select",""],["","00406012501","HYDROCODONE\/ACETAMINOPHEN ","10-325MG","14","Select","Select",""],["","00527128201","DICYCLOMINE HYDROCHLORIDE ","20MG","60","Select","Select",""],["","68645051654","AMLODIPINE BESYLATE ","10MG","30","Select","Select",""],["","68382013201","TAMSULOSIN HYDROCHLORIDE ","0.4MG","90","Select","Select",""],["","16571040250","CETIRIZINE HYDROCHLORIDE ","10MG","30","Select","Select",""],["","50383077916","LACTULOSE ","10GM\/15","450","Select","Select",""],["","00173068220","VENTOLIN HFA ","","18","Select","Select",""],["","59746017509","PREDNISONE ","20MG","20","Select","Select",""],["","00143928501","AMOXICILLIN ","875MG","20","Select","Select",""],["","69238149001","BUMETANIDE ","1MG","30","Select","Select",""],["","00310737020","BUDESONIDE\/FORMOTEROL FUMARATE DIHYDRATE ","160-4.5","10","Select","Select",""],["","55111018015","TIZANIDINE HYDROCHLORIDE ","4MG","90","Select","Select",""],["","57237007710","ONDANSETRON ODT ","4MG ODT","12","Select","Select",""],["","00186037020","SYMBICORT ","160-4.5","10","Select","Select",""],["","00093081001","NORTRIPTYLINE HYDROCHLORIDE ","10MG","30","Select","Select",""],["","49035045875","EQ ALLERGY RELIEF ","10MG","30","Select","Select",""],["","00093081301","NORTRIPTYLINE HCL ","75MG","-30","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","00069420030","VIAGRA ","25MG","30","Select","Select",""],["","00093505898","ATORVASTATIN CALCIUM ","40MG","30","Select","Select",""],["","10702025301","BUTALBITAL\/ACETAMINOPHEN\/CAFFEINE ","","28","Select","Select",""],["","31722094301","HYDROCODONE BITARTRATE\/ACETAMINOPHEN ","10-325MG","42","Select","Select",""],["","31604004070","D3 ","1000UNIT","30","Select","Select",""],["","00904549280","THERA-M ","","30","Select","Select",""],["","31722071030","SILDENAFIL CITRATE ","50MG","30","Select","Select",""],["","75834019701","HYDROCORTISONE ACETATE\/PRAMOXINE ","2.5-1%","30","Select","Select",""],["","50228018005","GABAPENTIN ","300MG","90","Select","Select",""],["","00002879959","HUMALOG KWIKPEN ","100\/ML","15","Select","Select",""],["","00088221905","LANTUS SOLOSTAR ","100\/ML","15","Select","Select",""],["","53885004601","ONETOUCH ULTRA 2 ","ULTRA 2","1","Select","Select",""],["","53885013610","ONETOUCH DELICA LANCETS EXTRA FINE 33G ","LANCETS","100","Select","Select",""],["","00487990401","ALBUTEROL SULFATE ","1.25MG\/3","-360","Select","Select",""],["","65162044211","MECLIZINE HYDROCHLORIDE ","25MG","60","Select","Select",""],["","63739019861","PEG 3350 ","","90","Select","Select",""],["","53885092701","ONETOUCH VERIO REFLECT ","VERIO RE","-1","Select","Select",""],["","53885027210","ONETOUCH VERIO TEST STRIPS ","VERIO","-100","Select","Select",""],["","00002771559","BASAGLAR KWIKPEN ","100UNIT","15","Select","Select",""],["","00002822259","INSULIN LISPRO KWIKPEN ","100\/ML","-15","Select","Select",""],["","16571041210","CIPROFLOXACIN HYDROCHLORIDE ","500MG","4","Select","Select",""],["","00169633910","NOVOLOG FLEXPEN ","FLEXPEN","-15","Select","Select",""],["","42806071401","BENZONATATE ","100MG","30","Select","Select",""],["","59746012106","MECLIZINE HCL ","25MG","60","Select","Select",""],["","67877021905","CEPHALEXIN ","500MG","20","Select","Select",""],["","00185005501","METOLAZONE ","5MG","30","Select","Select",""],["","55111015330","ONDANSETRON HYDROCHLORIDE ","4MG","30","Select","Select",""],["","52268001201","SUPREP BOWEL PREP KIT ","PREP KIT","354","Select","Select",""],["","00574200815","NYSTOP ","100000","30","Select","Select",""],["","00143924920","AMOXICILLIN\/CLAVULANATE POTASSIUM ","875-125","20","Select","Select",""],["","65862007930","TERBINAFINE HCL ","250MG","30","Select","Select",""],["","55111014512","FLUCONAZOLE ","150MG","1","Select","Select",""],["","51672127501","CLOTRIMAZOLE ","1%","15","Select","Select",""],["","50111033402","METRONIDAZOLE ","500MG","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":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"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":""}]}]}