{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BEVERLY   R SMITH","gend":1,"add":"2814 DEEP CREEK BLVD APT F","city":"PORTSMOUTH","state":"VA","zip":"23704-9998","dob":"1963-12-21","age":"","mstatus":"","insh":"20040180*01","cliId":"","pno":"757\/752-3880","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":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","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":["R19.7","G44.209","U07.1","L20.9","L85.3","I10.","E78.5","E78.2","R00.2","R00.0","I25.10","E11.9","M79.7","M19.90","Z87.891","Z79.82","Z79.899","J30.9","M47.816","H92.01","E11.42","L60.3","M19.071","M19.072","M77.31","M77.32","L60.0","M21.621","M21.622","M79.671","M79.672","R26.89","S13.4XXA","S80.01XA","S33.5XXA","R50.9","Z20.822","Z79.84","Z79.1","R05.","B35.9","S23.3XXA","Z12.31","L30.9","H25.13","H17.822","M25.572","M25.579","M14.671","F41.8","Z00.00","K08.409","Z78.9","N95.1","G47.00","F41.9","G43.909","M75.51","M14.672","R01.1","Z68.39","L29.9"],"date":["2021-02-08","2021-02-08","2021-02-08","2020-08-18","2020-08-18","2021-12-31","2021-10-05","2021-10-05","2021-12-31","2021-12-31","2021-12-31","2021-12-31","2021-12-31","2021-12-31","2021-12-31","2021-12-31","2021-12-31","2020-07-02","2020-07-02","2020-07-02","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2020-10-23","2020-10-23","2020-10-23","2021-02-03","2021-02-03","2021-02-03","2021-02-03","2021-08-09","2021-12-02","2020-09-19","2021-08-02","2019-03-01","2019-05-07","2019-05-07","2019-06-26","2019-06-26","2019-06-26","2019-10-30","2019-10-30","2019-10-30","2019-10-30","2019-12-13","2019-12-13","2019-08-28","2019-04-18","2019-06-05","2019-06-26","2019-01-14","2019-01-14","2019-05-16"],"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":[["","68645019059","METOPROL","TAB 50MG","30","Select","Select",""],["","00006027754","JANUVIA","TAB 100MG","30","Select","Select",""],["","50580029512","IMODIUM","TAB 2MG","20","Select","Select",""],["","00603254021","BUTAL\/APAP","TAB 50-325MG","90","Select","Select",""],["","67877041790","VALSARTAN","TAB 160MG","30","Select","Select",""],["","","LIDOCAINE","PAD 0.05","","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","30","Select","Select",""],["","","TRIAMCINOLON","CRE 0.001","","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA BL","100","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","90","Select","Select",""],["","","OMNARIS","SPR ","","Select","Select",""],["","72205002790","ROSUVASTATIN","TAB 5MG","15","Select","Select",""],["","50742062101","NIFEDIPINE","TAB 60MG ER","30","Select","Select",""],["","00597015390","JARDIANCE","TAB 25MG","30","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","49035052378","ACETAMINOPHN","TAB 325MG","20","Select","Select",""],["","43547040111","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","57664064888","CHLORTHALID","TAB 25MG","15","Select","Select",""],["","00228259711","INDAPAMIDE","TAB 1.25MG","30","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","","OMEPRAZOLE","CAP 20MG DR","","Select","Select",""],["","","SPIRONOLACT","TAB 25MG","","Select","Select",""],["","51672129801","KETOCONAZOLE","CRE 0.02","15","Select","Select",""],["","68645048154","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","13668000701","ZOLPIDEM","TAB 5MG","10","Select","Select",""],["","","CELECOXIB","CAP 100MG","","Select","Select",""],["","","PIMECROLIMUS","CRE 0.01","","Select","Select",""],["","","METHOCARBAM","TAB 500MG","","Select","Select",""],["","","ELIDEL","CRE 0.01","","Select","Select",""],["","","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","","IBUPROFEN","TAB 600MG","","Select","Select",""],["","","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","00093026215","FLUOCINONIDE","CRE 0.0005","15","Select","Select",""],["","68645051654","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","68645057054","CITALOPRAM","TAB 20MG","30","Select","Select",""],["","42195095510","BUT\/APAP\/CAF","CAP ","30","Select","Select",""],["","13811071230","VENLAFAXINE","TAB 37.5 ER","30","Select","Select",""],["","63481068447","VOLTAREN","GEL 0.01","100","Select","Select",""],["","16714035201","FLUOXETINE","CAP 20MG","90","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","00093005805","TRAMADOL","TAB 50MG","15","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":{"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":""}]}]}