{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BERNETTA THOMPSON","gend":1,"add":"719 SPENCE CIR","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1938-06-19","age":"","mstatus":"","insh":"20041452*01","cliId":"","pno":"757\/714-2386","cno":"","email":"","ename":"","eno":"","pphy":"MARKOVIC, VLADIMIR MD","ppno":"757\/533-9108","pcpadd":"3415 GRANBY STREET","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23504,"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\/622-6384","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G45.9","E16.2","N17.9","I10.","E13.9","I50.22","E78.2","E11.9","E78.5","E11.649","T38.3X5A","E83.52","E86.0","T50.2X5A","Z79.84","Z79.82","Z79.899","Z87.891","R53.1","Z23.","R11.2","I34.0","R19.7","R51.","E11.69","E66.9"],"date":["2020-06-05","2020-06-05","2020-06-05","2022-05-26","2021-12-30","2021-09-16","2022-05-26","2022-05-26","2020-06-03","2020-06-03","2020-06-03","2020-06-03","2020-06-03","2020-06-03","2022-05-26","2020-06-03","2020-06-03","2020-06-03","2020-06-03","2021-12-30","2020-03-23","2020-06-05","2020-02-10","2020-02-10","2020-06-03","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":[["","","GLIMEPIRIDE","TAB 2MG","","Select","Select",""],["","","BUPROPION","TAB 150MG SR","","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","","ROSUVASTATIN","TAB 20MG","","Select","Select",""],["","00597015230","JARDIANCE","TAB 10MG","30","Select","Select",""],["","29300013601","CLONIDINE","TAB 0.2MG","90","Select","Select",""],["","49281012165","FLUZONE","INJ 2021-22","1","Select","Select",""],["","00005200010","PREVNAR","INJ ","0","Select","Select",""],["","57664047758","METOPROL","TAB 50MG","60","Select","Select",""],["","","FUROSEMIDE","TAB 20MG","","Select","Select",""],["","23155010405","METFORMIN","TAB 1000MG","60","Select","Select",""],["","60505014202","GLIPIZIDE","TAB 10MG","30","Select","Select",""],["","68180052002","LISINOP\/HCTZ","TAB 20-25MG","30","Select","Select",""],["","00093720198","PRAVASTATIN","TAB 20MG","7","Select","Select",""],["","","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","","PROMETHAZINE","TAB 12.5MG","","Select","Select",""],["","","CHLORTHALID","TAB 25MG","","Select","Select",""],["","","SPIRONOLACT","TAB 25MG","","Select","Select",""],["","","ONETOUCH","TES ULTRA","","Select","Select",""],["","43547033810","BENAZEPRIL","TAB 40MG","30","Select","Select",""],["","13668011890","LOSARTAN\/HCT","TAB 100-25","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":""}]}]}