{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHAEL JEFFERSON","gend":0,"add":"208 LITTLE CREEK RD APT 24","city":"NORFOLK","state":"VA","zip":"23505-9998","dob":"1976-12-03","age":"","mstatus":"","insh":"20064184*01","cliId":"","pno":7577387871,"cno":7577387871,"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":["J96.21","F10.239","S03.00XA","E87.1","G40.909","J96.22","I10.","E13.9","Z87.19","Z12.11","Z68.42","Z23.","E11.9","K64.4","M25.50","NO DATA","J43.9","J45.40","F17.210","Z68.41","J44.1","E66.2","K70.10","S03.03XA","F14.90","E27.8","D69.6","Z20.822","R00.0","I16.0","J02.9","M15.0","J96.01","F10.10","B00.9","J02.8","B97.89","Z88.2","Z88.8","R07.0","I49.9","J44.9","F32.9","G47.30","N39.41","L60.8","M79.675","L85.1","L85.3","G47.33","R06.83","F17.200","E66.01","J84.10","E27.9","S02.2XXA","F33.3","F19.20","R55.","F33.2","M15.9","M05.79","R76.8"],"date":["2021-04-29","2021-05-01","2021-05-01","2021-05-01","2021-05-01","2021-04-29","2022-08-08","2021-11-22","2021-11-22","2021-11-22","2023-01-23","2021-11-22","2022-08-08","2022-08-08","2022-08-08","2022-12-23","2023-01-31","2023-01-31","2023-01-30","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-05-01","2021-04-27","2021-07-12","2022-02-22","2021-05-01","2021-05-17","2021-07-11","2021-07-11","2021-07-11","2021-07-11","2021-07-11","2021-07-11","2021-04-26","2021-12-06","2021-12-06","2021-07-12","2021-07-12","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2023-01-23","2023-01-23","2023-01-23","2023-01-23","2023-01-23","2021-05-17","2021-05-17","2021-12-15","2022-08-18","2021-04-27","2022-08-18","2022-12-23","2023-02-07","2023-02-07"],"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":[["","10006070021","VITAMIN B1","TAB 100MG","30","Select","Select",""],["","50228014605","HYDROCHLOROT","CAP 12.5MG","60","Select","Select",""],["","68382009205","CARVEDILOL","3.125 MG","180","Select","Select",""],["","80681000300","THEREMS","TAB MULTIVIT","30","Select","Select",""],["","11534016501","FOLIC ACID","1 MG","30","Select","Select",""],["","31604001281","B1","TAB 100MG","30","Select","Select",""],["","29300039805","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","68180063709","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","67877056105","METFORMIN","TAB 500MG","30","Select","Select",""],["","16571020110","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","55111064505","OMEPRAZOLE","40 MG","90","Select","Select",""],["","59267100002","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","50228046501","NABUMETONE","TAB 500MG","60","Select","Select",""],["","00378427693","VALACYCLOVIR","TAB 1GM","14","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","10","Select","Select",""],["","68462019001","NAPROXEN","500 MG","60","Select","Select",""],["","65162046650","IBUPROFEN","800 MG","60","Select","Select",""],["","42494030212","HYDROCORT AC","SUP 30MG","14","Select","Select",""],["","16477020212","HEMMOREX-HC","SUP 30MG","60","Select","Select",""],["","00173071720","ADVAIR HFA","AER 230\/21","12","Select","Select",""],["","45802049326","AMMONIUM LAC","CRE 0.12","385","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","69315031228","PROCTO-MED","CRE HC 2.5%","28","Select","Select",""],["","65649051112","PROCTOCORT","SUP 30MG","60","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","65862037401","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","58160084252","BOOSTRIX","INJ ","0","Select","Select",""],["","00005200010","PREVNAR 20","INJ ","0","Select","Select",""],["","30768015605","VITAMIN D","3 25 MCG","30","Select","Select",""],["","59746017206","PREDNISONE","5 MG","60","Select","Select",""],["","50228014605","HYDROCHLOROTHIAZIDE","12.5 MG","180","Select","Select",""],["","00054455015","METHOTREXATE","2.5 MG","12","Select","Select",""],["","63304082990","ATORVASTATIN CALCIUM","40 MG","90","Select","Select",""],["","43386009019","GAVILYTE-G","236-22.74G","4000","Select","Select",""],["","67877056105","METFORMIN HCL","500 MG","90","Select","Select",""],["","29300039805","AMLODIPINE BESYLATE","10 MG","90","Select","Select",""],["","50228014605","HYDROCHLOROT CAP","12.5MG","60","Select","Select",""],["","11534016501","FOLIC ACID TAB","1MG","30","Select","Select",""],["","68382009201","CARVEDILOL TAB","3.125MG","180","Select","Select",""],["","00173071720","ADVAIR HFA AER","230\/21","12","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","65862037401","ESCITALOPRAM TAB","10MG","30","Select","Select",""],["","67877056105","METFORMIN TAB","500MG","90","Select","Select",""],["","70010013901","NAPROXEN TAB","500MG","60","Select","Select",""],["","00005200010","PREVNAR","20 INJ","0","Select","Select",""],["","29300039805","AMLODIPINE TAB","10MG","90","Select","Select",""],["","68180063709","ATORVASTATIN TAB","40MG","90","Select","Select",""],["","55111064505","OMEPRAZOLE CAP","40MG","90","Select","Select",""],["","58160084252","BOOSTRIX INJ","","0","Select","Select",""],["","42494030212","HYDROCORT AC SUP","30MG","14","Select","Select",""],["","69315031228","PROCTO-MED CRE HC","2.5%","28","Select","Select",""],["","00406051201","OXYCOD\/APAP TAB","5-325MG","10","Select","Select",""],["","59746017206","PREDNISONE TAB","5MG","60","Select","Select",""],["","30768015605","VITAMIN D CAP","1000UNIT","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":""}]}]}