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medax_pipeline/testData/Jimmie93_Pfeffer420_b60cecd8-24c6-7983-3915-3bd6e8ede863.json
Tom Gebhardt a9db0be88a release commit
2025-04-16 22:12:19 +02:00

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},
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}, {
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}, {
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},
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}, {
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}, {
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},
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}, {
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}, {
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}, {
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},
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}, {
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},
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}, {
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"text": "Do you consider yourself Hispanic/Latino?"
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"text": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]"
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},
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} ],
"code": {
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},
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}
},
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}, {
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} ],
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} ],
"text": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]"
},
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},
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}
}, {
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} ],
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},
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}
}, {
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} ],
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},
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}, {
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},
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},
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}
}, {
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} ],
"text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?"
},
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}, {
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},
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}, {
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},
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},
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},
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}, {
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} ],
"text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?"
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}
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"text": "Race"
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}, {
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} ],
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},
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}, {
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} ],
"text": "Systolic Blood Pressure"
},
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},
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} ],
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},
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},
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} ],
"code": {
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} ],
"text": "Tobacco smoking status"
},
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}
},
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}, {
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} ],
"code": {
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} ],
"text": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]"
},
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},
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}
}, {
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} ],
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},
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}
}, {
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} ],
"text": "Are you a refugee?"
},
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}, {
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} ],
"text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?"
},
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} ],
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}
}, {
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},
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} ],
"text": "A little bit"
}
}, {
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} ],
"text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?"
},
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}, {
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},
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}, {
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} ],
"text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?"
},
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}, {
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} ],
"text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?"
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},
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}, {
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},
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}
}, {
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"text": "Highest level of education"
},
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"text": "More than high school"
}
}, {
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} ],
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"text": "Are you worried about losing your housing?"
},
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}, {
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}, {
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"text": "How many people are living or staying at this address?"
},
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"text": "Preferred language"
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} ],
"text": "Have you been discharged from the armed forces of the United States?"
},
"valueCodeableConcept": {
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} ],
"text": "No"
}
}, {
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"display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?"
} ],
"text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?"
},
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}
}, {
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},
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} ],
"text": "White"
}
}, {
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} ],
"text": "Do you consider yourself Hispanic/Latino?"
},
"valueCodeableConcept": {
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"text": "No"
}
} ]
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}, {
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} ],
"code": {
"coding": [ {
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"display": "Total score [HARK]"
} ],
"text": "Total score [HARK]"
},
"subject": {
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},
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}, {
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}, {
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},
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"text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?"
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}, {
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}, {
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},
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},
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"text": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]"
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"text": "Total score [HARK]"
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}, {
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"text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?"
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}, {
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}, {
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},
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}, {
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}, {
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},
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}, {
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}, {
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"text": "Do you consider yourself Hispanic/Latino?"
},
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"text": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]"
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},
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"code": {
"coding": [ {
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"text": "Tobacco smoking status"
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},
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}, {
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"code": {
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"text": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]"
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},
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}, {
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} ],
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},
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}, {
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} ],
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},
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}, {
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} ],
"text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?"
},
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}, {
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},
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} ],
"text": "Not at all"
}
}, {
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} ],
"text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?"
},
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}, {
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},
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}, {
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} ],
"text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?"
},
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}, {
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} ],
"text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?"
},
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}, {
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},
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"text": "Medicaid"
}
}, {
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},
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}
}, {
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"text": "Highest level of education"
},
"valueCodeableConcept": {
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"text": "More than high school"
}
}, {
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} ],
"text": "Address"
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"valueString": "815 Hodkiewicz Well Apt 2"
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"text": "Are you worried about losing your housing?"
},
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"text": "No"
}
}, {
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"text": "Housing status"
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}
}, {
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} ],
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},
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"display": "Preferred language"
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"text": "Preferred language"
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} ],
"text": "English"
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"text": "Have you been discharged from the armed forces of the United States?"
},
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}
}, {
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"text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?"
},
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}, {
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"text": "Race"
},
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}
}, {
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} ],
"text": "Do you consider yourself Hispanic/Latino?"
},
"valueCodeableConcept": {
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"text": "No"
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}, {
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} ],
"code": {
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"display": "Total score [HARK]"
} ],
"text": "Total score [HARK]"
},
"subject": {
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} ],
"code": {
"coding": [ {
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"display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]"
} ],
"text": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]"
},
"subject": {
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} ],
"code": {
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} ],
"text": "Total score [AUDIT-C]"
},
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} ],
"code": {
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}, {
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}, {
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},
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}, {
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},
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}, {
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},
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}, {
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}, {
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} ],
"text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?"
},
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},
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}, {
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}, {
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}, {
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"text": "Highest level of education"
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}, {
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},
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} ],
"text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?"
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"text": "Race"
},
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}, {
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"text": "Do you consider yourself Hispanic/Latino?"
},
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} ],
"code": {
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"text": "Total score [HARK]"
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2023-07-07

# Chief Complaint
No complaints.

# History of Present Illness
Jimmie93
 is a 26 year-old nonhispanic white male. Patient has a history of streptococcal sore throat (disorder), acute bacterial sinusitis (disorder), medication review due (situation), acute viral pharyngitis (disorder), victim of intimate partner abuse (finding), viral sinusitis (disorder), acute bronchitis (disorder), part-time employment (finding), risk activity involvement (finding), not in labor force (finding), limited social contact (finding), unhealthy alcohol drinking behavior (finding), full-time employment (finding), stress (finding).

# Social History
 Patient has never smoked.
 Patient identifies as heterosexual.

Patient comes from a middle socioeconomic background.
 Patient has completed some college courses.
Patient currently has Medicaid.

# Allergies
No Known Allergies.

# Medications
penicillin v potassium 250 mg oral tablet; lisinopril 10 mg oral tablet; acetaminophen 325 mg oral tablet; acetaminophen 325 mg / oxycodone hydrochloride 10 mg oral tablet [percocet]; amlodipine 2.5 mg oral tablet; tramadol hydrochloride 50 mg oral tablet

# Assessment and Plan
Patient is presenting with patient transfer to skilled nursing facility (procedure). 

## Plan

The following procedures were conducted:
- history and physical examination (procedure)
- initial patient assessment (procedure)
- development of individualized plan of care (procedure)
- nursing care/supplementary surveillance (regime/therapy)
- professional / ancillary services care (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- occupational therapy (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- physical therapy procedure (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- occupational therapy (regime/therapy)
- professional / ancillary services care (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- professional / ancillary services care (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- speech and language therapy regime (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- occupational therapy (regime/therapy)
- speech and language therapy regime (regime/therapy)
- professional / ancillary services care (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- professional / ancillary services care (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
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- physical therapy procedure (regime/therapy)
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- physical therapy procedure (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- pre-discharge assessment (procedure)
- discharge from skilled nursing facility (procedure)
"
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2023-07-07

# Chief Complaint
No complaints.

# History of Present Illness
Jimmie93
 is a 26 year-old nonhispanic white male. Patient has a history of streptococcal sore throat (disorder), acute bacterial sinusitis (disorder), medication review due (situation), acute viral pharyngitis (disorder), victim of intimate partner abuse (finding), viral sinusitis (disorder), acute bronchitis (disorder), part-time employment (finding), risk activity involvement (finding), not in labor force (finding), limited social contact (finding), unhealthy alcohol drinking behavior (finding), full-time employment (finding), stress (finding).

# Social History
 Patient has never smoked.
 Patient identifies as heterosexual.

Patient comes from a middle socioeconomic background.
 Patient has completed some college courses.
Patient currently has Medicaid.

# Allergies
No Known Allergies.

# Medications
penicillin v potassium 250 mg oral tablet; lisinopril 10 mg oral tablet; acetaminophen 325 mg oral tablet; acetaminophen 325 mg / oxycodone hydrochloride 10 mg oral tablet [percocet]; amlodipine 2.5 mg oral tablet; tramadol hydrochloride 50 mg oral tablet

# Assessment and Plan
Patient is presenting with patient transfer to skilled nursing facility (procedure). 

## Plan

The following procedures were conducted:
- history and physical examination (procedure)
- initial patient assessment (procedure)
- development of individualized plan of care (procedure)
- nursing care/supplementary surveillance (regime/therapy)
- professional / ancillary services care (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- occupational therapy (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- physical therapy procedure (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- occupational therapy (regime/therapy)
- professional / ancillary services care (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- professional / ancillary services care (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- speech and language therapy regime (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- occupational therapy (regime/therapy)
- speech and language therapy regime (regime/therapy)
- professional / ancillary services care (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- professional / ancillary services care (regime/therapy)
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- nursing care/supplementary surveillance (regime/therapy)
- physical therapy procedure (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- nursing care/supplementary surveillance (regime/therapy)
- pre-discharge assessment (procedure)
- discharge from skilled nursing facility (procedure)
"
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"recorded": "2023-09-11T01:23:18.760+02:00",
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}
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