{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"THERESA L HOPKINS","gend":1,"add":"1846 E LITTLE CREEK ROAD APT 17","city":"NORFOLK","state":"VA","zip":"23518-9998","dob":"1955-12-26","age":"","mstatus":"","insh":"900041739*01","cliId":"","pno":"757\/971-2807","cno":"","email":"","ename":"","eno":"","pphy":"WELLS, JANELLE M MD","ppno":"757\/393-6363","pcpadd":"664 LINCOLN ST","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":23704,"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":["J45.50","G47.33","F17.200","R07.9","E11.40","L60.0","L97.511","D48.5","L82.0","L81.8","K64.8","D50.9","K59.00","K62.89","K62.5","R06.02","R05.","K21.00","R09.82","I10.","G47.00","E66.9","E11.9","Z79.4","R05.9","R00.0","D64.9","Z88.5","Z88.0","R68.89","Z20.822","D22.61","D22.62","D22.5","L81.4","L53.8","Z78.9","L30.8","Z12.31","E11.65","Z11.52","E08.29","H53.143","E11.3293","H25.13","H52.03","F51.01","E55.9","E66.01","E78.2","D17.1","R53.83","F41.8","Z72.821","J45.909","I50.30"],"date":["2021-12-15","2021-12-15","2021-12-15","2021-12-20","2020-12-30","2020-12-30","2020-12-30","2021-11-23","2021-11-23","2021-02-02","2021-04-15","2021-04-15","2021-04-15","2021-04-15","2021-04-15","2021-11-11","2021-05-21","2021-09-15","2021-05-21","2021-10-26","2021-08-04","2021-08-04","2021-11-11","2021-11-05","2021-11-11","2021-11-11","2021-11-11","2021-11-11","2021-11-11","2021-11-11","2021-11-11","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-07-06","2021-09-02","2021-10-04","2021-01-18","2021-03-26","2021-03-26","2021-03-26","2021-03-26","2021-04-28","2021-04-28","2021-10-26","2021-10-26","2021-11-23","2021-01-29","2021-01-29","2021-01-29","2021-05-11","2021-06-17"],"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":[["","00169633910","NOVOLOG FLEXPEN ","FLEXPEN","15","Select","Select",""],["","00088221905","LANTUS SOLOSTAR ","100\/ML","15","Select","Select",""],["","67877025145","TRIAMCINOLONE ACETONIDE ","0.10%","454","Select","Select",""],["","46287001016","TRIAMCINOLONE ACETONIDE IN ABSORBASE ","0.05%","430","Select","Select",""],["","54295030825","UREA ","40%","198","Select","Select",""],["","57599000101","FREESTYLE LIBRE 14 DAY\/SENSOR\/FLASH MONITORING SYSTEM ","SENSOR","2","Select","Select",""],["","73070010315","INSULIN ASPART FLEXPEN ","FLEXPEN","-15","Select","Select",""],["","16729017217","AMITRIPTYLINE HCL ","25MG","30","Select","Select",""],["","65862052405","GABAPENTIN ","800MG","90","Select","Select",""],["","64980032430","PROCTOZONE-HC ","-HC 2.5%","60","Select","Select",""],["","59746033990","LOSARTAN POTASSIUM\/HYDROCHLOROTHIAZIDE ","100-25","30","Select","Select",""],["","00456120130","LINZESS ","145MCG","90","Select","Select",""],["","00713050324","ANUCORT-HC ","25MG","28","Select","Select",""],["","68462083617","HYDROCORTISONE VALERATE ","0.20%","15","Select","Select",""],["","59310057922","PROAIR HFA ","","8","Select","Select",""],["","57599000200","FREESTYLE LIBRE 14 DAY\/READER\/FLASH MONITORING SYSTEM ","READER","1","Select","Select",""],["","68180044501","QUETIAPINE FUMARATE ","25MG","30","Select","Select",""],["","53191036201","D3-50 ","50000UNT","12","Select","Select",""],["","00173071720","ADVAIR HFA ","230\/21","12","Select","Select",""],["","42806054701","VITAMIN D ","1.25MG","12","Select","Select",""],["","00173088210","BREO ELLIPTA ","200-25","180","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA ","HFA","26","Select","Select",""],["","00006027731","JANUVIA ","100MG","90","Select","Select",""],["","55111064530","OMEPRAZOLE ","40MG","180","Select","Select",""],["","00169210125","NOVOLOG FLEXPEN RELION ","FLEXPEN","15","Select","Select",""],["","08627005303","DEXCOM G6 SENSOR ","SENSOR","9","Select","Select",""],["","55111015330","ONDANSETRON HYDROCHLORIDE ","4MG","60","Select","Select",""],["","08627001601","DEXCOM G6 TRANSMITTER ","TRANSMIT","1","Select","Select",""],["","08627002021","DEXCOM G4 PLATINUM RECEIVER KIT ","RECEIVER","1","Select","Select",""],["","55111014512","FLUCONAZOLE ","150MG","1","Select","Select",""],["","50111078710","AZITHROMYCIN ","250MG","6","Select","Select",""],["","62542030117","HYDROCODONE POLISTIREX\/CHLORPHENIRAMINE POLISTIREX ","10-8\/5ML","100","Select","Select",""],["","42806071401","BENZONATATE ","100MG","30","Select","Select",""],["","80681017401","VITAMIN D3 ","1.25MG","12","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}