{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CARMEN SIERRA","gend":1,"add":"1516 HARMON ST","city":"NORFOLK","state":"VA","zip":"23518-9998","dob":"1964-05-06","age":"","mstatus":"","insh":"20034937*01","cliId":"","pno":7573784623,"cno":7573784623,"email":"","ename":"","eno":"","pphy":"MARKOVIC, VLADIMIR MD","ppno":7575339108,"pcpadd":"155 KINGSLEY LANE SUITE 320,","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23505-9998","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":7576226384,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.2","F14.20","F10.20","F17.209","R53.1","B34.9","Z20.822","I10.","F33.3","F14.21","V62.84","M17.0","J44.9","Z87.891","Z88.0","M25.561","F31.9","F14.10","F39.","Z65.8","F17.200","F29.","R07.89","D72.829","R05.9","R06.02","F43.10","Z80.1","R07.9","F22.","F31.60","M25.562","M12.9","F31.12","Z62.810","E11.9","E66.9","N32.81","F33.2","Z91.14","F10.10","F17.210","Z59.00","Z59.86","Z79.899","Z79.51","Z79.1","Z91.51","NO DATA","R10.84","K92.0","R42.","M17.11","R44.1","R04.0","F41.0","R05.3","F32.9","Z13.89","R52.","Z76.0","G89.29","J45.40","R05.","Z68.29","R45.88","S40.812A","S40.811A","R44.3","Z68.30","F19.10","M62.81","Z87.39","F31.64","F14.259","N39.0","F14.24","E55.9","J42.","Z59.819","Z91.52","N30.00"],"date":["2022-12-04","2022-12-20","2022-12-11","2022-12-20","2022-12-28","2022-12-28","2022-12-28","2023-09-09","2022-10-19","2022-10-19","2023-09-17","2023-09-09","2023-09-09","2023-08-07","2022-12-28","2023-08-07","2022-11-04","2023-09-17","2022-10-01","2022-07-16","2022-07-16","2022-07-16","2022-08-11","2022-08-04","2022-12-28","2022-08-04","2023-04-29","2022-08-04","2022-08-04","2022-11-04","2021-03-23","2023-08-07","2022-02-24","2022-12-04","2022-10-01","2022-10-01","2022-10-01","2022-10-01","2022-10-01","2022-12-04","2022-12-04","2023-09-09","2022-12-04","2022-12-04","2022-12-04","2022-12-04","2022-12-04","2022-12-04","2023-09-07","2023-04-29","2023-04-29","2023-04-29","2023-04-26","2022-10-28","2021-10-20","2022-02-07","2023-08-07","2022-11-17","2022-11-17","2022-12-28","2021-06-15","2023-08-07","2021-06-15","2021-06-15","2021-06-15","2022-10-28","2022-10-28","2022-10-28","2022-10-28","2021-02-12","2023-09-07","2023-04-26","2023-08-07","2023-09-09","2023-09-09","2023-09-09","2023-09-09","2023-09-09","2023-09-09","2023-09-09","2023-09-09","2023-09-17"],"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":[]},{"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":[["","29300039805","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","57237000830","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","63824000820","MUCINEX","TAB 600MG ER","28","Select","Select",""],["","00173085910","BREO ELLIPTA","INH 100-25","60","Select","Select",""],["","16729017001","ESCITALOPRAM","TAB 20MG","30","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00115180301","HYDROXYZ PAM","CAP 25MG","15","Select","Select",""],["","11822771100","RA TUSSIN","LIQ 100\/5ML","240","Select","Select",""],["","68382005101","MELOXICAM","TAB 15MG","90","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","16729018317","HYDROCHLOROT","TAB 25MG","7","Select","Select",""],["","10939090644","SM MUCUS REL","TAB 600MG ER","8","Select","Select",""],["","58657050916","GUAIFENESIN","LIQ 100\/5ML","237","Select","Select",""],["","66993013597","FLUTIC\/VILAN","INH 100-25","60","Select","Select",""],["","11822573130","TUSSIN CGH\/","LIQ COLD CF","237","Select","Select",""],["","00378397993","PALIPERIDONE","TAB ER 3MG","60","Select","Select",""],["","11822042030","SALINE NASAL","SPR 0.0065","45","Select","Select",""],["","50488102502","CAPSAICIN","CRE 0.00025","125","Select","Select",""],["","57896020110","PAIN RELIEF","500 MG","30","Select","Select",""],["","65162046650","IBUPROFEN","TAB 800MG","90","Select","Select",""],["","11822333230","RA TUSSIN DM","LIQ 100-10\/5","118","Select","Select",""],["","00173086910","ANORO ELLIPT","AER 62.5-25","60","Select","Select",""],["","70010016201","LORATADINE","TAB 10MG","30","Select","Select",""],["","42806071401","BENZONATATE","100 MG","42","Select","Select",""],["","52817018000","CLONIDINE","TAB 0.1MG","20","Select","Select",""],["","13668021730","ARIPIPRAZOLE","TAB 5MG","7","Select","Select",""],["","42799060501","LOPERAMIDE","CAP 2MG","10","Select","Select",""],["","13668033005","TRAZODONE","TAB 50MG","7","Select","Select",""],["","00536132710","ACETAMINOPHE","TAB 325MG","60","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","10","Select","Select",""],["","13668000905","CITALOPRAM","TAB 10MG","7","Select","Select",""],["","80681002000","MULTIVITAMIN","TAB ","30","Select","Select",""],["","00527058610","DICYCLOMINE","CAP 10MG","10","Select","Select",""],["","66993013597","FLUTICASONE-VILANTEROL","100-25MCG","60","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","90 MCG","18","Select","Select",""],["","00597007541","SPIRIVA HANDIHALER","18 MCG","90","Select","Select",""],["","68462019001","NAPROXEN","500 MG","20","Select","Select",""],["","00172208380","HYDROCHLOROTHIAZIDE","25 MG","30","Select","Select",""],["","29300039805","AMLODIPINE BESYLATE","10 MG","30","Select","Select",""],["","16729017001","ESCITALOPRAM TAB","20MG","30","Select","Select",""],["","59310057922","PROAIR HFA AER","","26","Select","Select",""],["","57237000830","MIRTAZAPINE TAB","15MG","30","Select","Select",""],["","29300039805","AMLODIPINE TAB","10MG","90","Select","Select",""],["","00173085910","BREO ELLIPTA INH","100-25","60","Select","Select",""],["","63824000820","MUCINEX TAB","600MG ER","28","Select","Select",""],["","00597007541","SPIRIVA CAP HANDIHLR","","90","Select","Select",""],["","00115180301","HYDROXYZ PAM CAP","25MG","15","Select","Select",""],["","68382005101","MELOXICAM TAB","15MG","90","Select","Select",""],["","11822771100","RA TUSSIN LIQ","100\/5ML","240","Select","Select",""],["","00172208380","HYDROCHLOROT TAB","25MG","30","Select","Select",""],["","66993001968","ALBUTEROL AER HFA","","18","Select","Select",""],["","10939090644","SM MUCUS REL TAB","600MG ER","20","Select","Select",""],["","58657050916","GUAIFENESIN LIQ","100\/5ML","237","Select","Select",""],["","11822573130","TUSSIN CGH\/ LIQ COLD CF","","237","Select","Select",""],["","00378397993","PALIPERIDONE TAB ER","3MG","14","Select","Select",""],["","70010016201","LORATADINE TAB","10MG","30","Select","Select",""],["","50488102502","CAPSAICIN CRE","0.025%","125","Select","Select",""],["","11822010233","PAIN RELIEF TAB","500MG","120","Select","Select",""],["","66993013597","FLUTIC\/VILAN INH","100-25","60","Select","Select",""],["","00173086910","ANORO ELLIPT AER","62.5-25","60","Select","Select",""],["","11822042030","SALINE NASAL SPR","0.65%","45","Select","Select",""],["","65162046650","IBUPROFEN TAB","800MG","90","Select","Select",""],["","11822333230","RA TUSSIN DM LIQ","100-10\/5","118","Select","Select",""],["","13668033005","TRAZODONE TAB","50MG","7","Select","Select",""],["","42806071401","BENZONATATE CAP","100MG","42","Select","Select",""],["","00527058610","DICYCLOMINE CAP","10MG","10","Select","Select",""],["","13668021730","ARIPIPRAZOLE TAB","5MG","7","Select","Select",""],["","00536132710","ACETAMINOPHE TAB","325MG","60","Select","Select",""],["","68462010530","ONDANSETRON TAB","4MG","10","Select","Select",""],["","13668000905","CITALOPRAM TAB","10MG","7","Select","Select",""],["","52817018000","CLONIDINE TAB","0.1MG","20","Select","Select",""],["","80681002000","MULTIVITAMIN TAB","","30","Select","Select",""],["","42799060501","LOPERAMIDE CAP","2MG","10","Select","Select",""],["","00406055201","OXYCODONE HCL","5 MG","3","Select","Select",""],["","45802095301","DICLOFENAC SODIUM","1 %","100","Select","Select",""],["","00093314705","CEPHALEXIN","500 MG","20","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":""}]}]}