{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LARRY WESCOTT","gend":0,"add":"4 CARRINGTON CT E","city":"PORTSMOUTH","state":"VA","zip":"23701-9998","dob":"1975-07-20","age":"","mstatus":"","insh":"20068385*01","cliId":"","pno":7579980612,"cno":7579980612,"email":"","ename":"","eno":"","pphy":"MARKOVIC, VLADIMIR MD","ppno":7575339108,"pcpadd":"3415 GRANBY STREET,","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23504-9998","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":["F31.5","H43.12","H40.013","Z01.818","E11.65","H25.043","R42.","R55.","K59.00","R93.89","E11.40","F17.210","Z79.4","R11.10","R10.84","Z79.899","R35.89","S71.131A","S70.11XA","E11.42","R10.33","E11.9","Z72.0","Z72.89","R10.11","E10.8","K25.9","E11.3493","Z79.84","H25.813","E11.3592","H35.032","M62.830","E78.00","N52.9","M79.2","Z12.11","E66.3","I10.","E55.9","Z13.89","F17.200","R73.09","R53.83","E11.3391","H35.033","E11.3393","S71.111A","R40.2410","T14.8XXD","Z48.02","F33.0"],"date":["2022-02-01","2022-06-28","2022-06-13","2022-07-25","2023-01-03","2022-09-27","2022-08-30","2021-06-12","2022-11-15","2022-01-06","2022-04-11","2022-08-30","2023-01-03","2022-01-06","2022-04-11","2022-08-30","2022-08-30","2021-08-05","2021-08-05","2023-04-17","2021-04-08","2022-11-22","2022-03-01","2021-04-08","2022-01-06","2022-01-06","2023-04-17","2023-02-16","2022-05-04","2022-05-04","2022-08-12","2022-06-28","2021-03-19","2022-02-07","2022-02-07","2022-02-07","2022-11-15","2022-11-15","2023-04-17","2023-04-17","2023-04-17","2021-10-04","2022-04-11","2022-06-27","2022-08-12","2022-08-12","2022-05-31","2021-08-06","2021-08-06","2021-08-20","2021-08-20","2023-06-02"],"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":[["","71093011105","GABAPENTIN","600 MG","60","Select","Select",""],["","00169643810","LEVEMIR","INJ FLEXTOUC","15","Select","Select",""],["","70377002911","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA","200","Select","Select",""],["","00002751101","HUMALOG MIX","SUS 75\/25","20","Select","Select",""],["","64980028101","GLIPIZIDE ER","10 MG","90","Select","Select",""],["","00093221001","SUCRALFATE","1 G","60","Select","Select",""],["","00378668910","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","67877056310","METFORMIN","TAB 1000MG","180","Select","Select",""],["","53885001110","ONETOUCH DEL","MIS PLUS 30G","200","Select","Select",""],["","00093598627","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","57599000101","FREESTYLE","KIT SENSOR","2","Select","Select",""],["","45802048678","DOCUSATE SOD","CAP 100MG","60","Select","Select",""],["","00169369619","NOVOLOG MIX","70-30 FLEXPEN 70-30\/ML","30","Select","Select",""],["","08290320550","BD PEN NEEDL","MIS 32GX4MM","200","Select","Select",""],["","65862086001","FAMOTIDINE","40 MG","90","Select","Select",""],["","75834002001","VITAMIN D3","CAP 50000UNT","4","Select","Select",""],["","00002143480","TRULICITY","1.5 MG\/0.5","6","Select","Select",""],["","24208046325","LATANOPROST","SOL 0.00005","2","Select","Select",""],["","00832141003","MOXIFLOXACIN","SOL HCL 0.5%","3","Select","Select",""],["","42571013725","KETOROLAC","SOL 0.005","5","Select","Select",""],["","60758011905","PREDNISOLONE","SUS 1% OP","5","Select","Select",""],["","00093534356","SILDENAFIL","TAB 100MG","90","Select","Select",""],["","67877056310","METFORMIN HCL","1000 MG","180","Select","Select",""],["","53885001110","ONETOUCH DELICA PLUS LANCET","30 GAUGE","200","Select","Select",""],["","00378668910","PANTOPRAZOLE SODIUM","40 MG","90","Select","Select",""],["","75834002001","VITAMIN D","3 1250 MCG","12","Select","Select",""],["","70377002911","ATORVASTATIN CALCIUM","40 MG","90","Select","Select",""],["","08290320550","NANO","2ND GEN PEN NEEDLE 32GX 5\/32\"","200","Select","Select",""],["","71093011105","GABAPENTIN TAB","600MG","180","Select","Select",""],["","45802048678","DOCUSATE SOD CAP","100MG","60","Select","Select",""],["","00169643810","LEVEMIR INJ FLEXTOUC","","15","Select","Select",""],["","00093221001","SUCRALFATE TAB","1GM","60","Select","Select",""],["","64980028101","GLIPIZIDE ER TAB","10MG","30","Select","Select",""],["","53885024510","ONETOUCH TES ULTRA","","200","Select","Select",""],["","00093598627","EPINEPHRINE INJ","0.3MG","2","Select","Select",""],["","00002751101","HUMALOG MIX SUS","75\/25","20","Select","Select",""],["","67877056310","METFORMIN TAB","1000MG","60","Select","Select",""],["","53885001110","ONETOUCH DEL MIS PLUS","30G","200","Select","Select",""],["","00378668910","PANTOPRAZOLE TAB","40MG","90","Select","Select",""],["","70377002911","ATORVASTATIN TAB","40MG","90","Select","Select",""],["","57599000101","FREESTYLE KIT SENSOR","","2","Select","Select",""],["","00169369619","NOVOLOG MIX INJ FLEXPEN","","15","Select","Select",""],["","24208046325","LATANOPROST SOL","0.005%","2","Select","Select",""],["","57599000200","FREESTYLE MIS READER","","2","Select","Select",""],["","65862086001","FAMOTIDINE TAB","40MG","90","Select","Select",""],["","08290320550","BD PEN NEEDL MIS","32GX4MM","200","Select","Select",""],["","00002143380","TRULICITY INJ","0.75\/0.5","2","Select","Select",""],["","60758011905","PREDNISOLONE SUS","1% OP","5","Select","Select",""],["","42571013725","KETOROLAC SOL","0.5%","5","Select","Select",""],["","00832141003","MOXIFLOXACIN SOL HCL","0.5%","3","Select","Select",""],["","00093534356","SILDENAFIL TAB","100MG","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":""}]}]}