{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RICHARD BURRUS","gend":0,"add":"2212 ST DENIS AVE PO BOX 61696","city":"NORFOLK","state":"VA","zip":"23509-9998","dob":"1961-04-28","age":"","mstatus":"","insh":"20042978*01","cliId":"","pno":4344308100,"cno":4344308100,"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":["R03.0","J45.909","Z71.1","R52.","Z68.27","L20.9","T40.1X1A","R55.","S60.512A","S60.511A","Z87.891","T50.904A","F11.20","I10.","L81.8","K62.5","Z23.","J30.9","F14.20","F25.0","F11.10","R41.0","R07.9","F11.90","L30.9","R41.82","Z76.89","R21.","Z11.3","R30.0","Z68.29","K08.89","Z91.09","N48.89","E66.3","Z68.28","B00.9","T50.901A","R00.0","F33.3","F12.20","F33.1"],"date":["2021-01-26","2021-09-28","2021-06-25","2021-06-25","2021-06-25","2022-06-08","2023-08-30","2022-11-29","2022-11-29","2022-11-29","2023-08-29","2022-11-29","2023-09-19","2021-10-07","2021-10-07","2021-11-15","2021-11-15","2021-11-15","2023-05-29","2022-08-19","2022-10-12","2023-03-29","2023-07-03","2023-03-29","2021-07-16","2023-03-29","2021-04-23","2021-09-28","2021-04-23","2021-04-23","2021-04-23","2021-11-18","2021-11-18","2022-02-01","2022-02-01","2022-02-01","2021-09-28","2023-03-29","2023-03-29","2023-06-27","2023-06-27","2023-06-26"],"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":[["","21922001707","CLOBETASOL","OIN 0.0005","60","Select","Select",""],["","67877025145","TRIAMCINOLON","CRE 0.001","454","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00093216568","NALOXONE HCL","4 MG","2","Select","Select",""],["","43598058230","BUPREN\/NALOX","MIS 8-2MG","11","Select","Select",""],["","00781717612","NALOXONE","SPR 4MG","2","Select","Select",""],["","12496120803","SUBOXONE","8 MG-2 MG","14","Select","Select",""],["","69547035302","NARCAN","SPR 4MG","2","Select","Select",""],["","00115180301","HYDROXYZINE PAMOATE","25 MG","20","Select","Select",""],["","43598058230","BUPRENORPHINE-NALOXONE","8 MG-2 MG","14","Select","Select",""],["","29300046810","CLONIDINE HCL","0.1 MG","15","Select","Select",""],["","00093031101","LOPERAMIDE","2 MG","20","Select","Select",""],["","21922001707","CLOBETASOL OIN","0.05%","60","Select","Select",""],["","67877025145","TRIAMCINOLON CRE","0.1%","454","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","43598058230","BUPREN\/NALOX MIS","8-2MG","10","Select","Select",""],["","12496120803","SUBOXONE MIS","8-2MG","11","Select","Select",""],["","00093216568","NALOXONE HCL SPR","4MG","2","Select","Select",""],["","00781717612","NALOXONE SPR","4MG","2","Select","Select",""],["","69547035302","NARCAN SPR","4MG","2","Select","Select",""],["","16729044310","BUPROPION XL","150 MG","30","Select","Select",""],["","69452015120","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","61958200201","DESCOVY","200MG-25MG","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":""}]}]}