{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RHONDA FULLER","gend":1,"add":"137 MOOREFIELD LN APT G","city":"DANVILLE","state":"VA","zip":"24541-9998","dob":"1971-07-01","age":"","mstatus":"","insh":"20027599*01","cliId":"","pno":"434\/728-0197","cno":"434\/728-0197","email":"","ename":"","eno":"","pphy":"WATERS, MICHAEL MD","ppno":"434\/797-2828","pcpadd":"125 EXECUTIVE DRIVE","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":133812,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.4","E11.9","H10.413","N76.0","N89.8","L03.316","R42.","E08.65","N81.3","N81.6","K59.00","D25.9","E11.65","G70.00","E66.9","B20.","Z01.419","N81.9","Z87.410","B37.3","G25.81","I10.","Z72.0","J45.20","E78.2","Z20.828","L29.2","R73.9","R87.610","Z87.19","Z87.411","D01.3","R85.81","Z91.89","Z11.3","Z78.0","G89.18","N81.2","Z97.5","N93.9","M25.552","M54.32","M54.9","Z23."],"date":["2021-04-27","2021-08-20","2020-03-09","2020-12-05","2020-01-10","2020-08-28","2020-11-10","2020-11-10","2020-12-14","2020-12-14","2020-12-14","2020-12-14","2021-06-14","2021-02-12","2021-02-12","2021-07-15","2020-08-13","2020-12-14","2021-06-14","2021-06-14","2021-01-06","2020-09-09","2021-06-14","2020-06-09","2021-06-14","2020-11-07","2020-11-07","2020-11-07","2021-01-06","2021-06-14","2021-06-14","2021-06-14","2021-06-14","2021-06-14","2021-06-14","2021-06-14","2021-06-14","2020-12-14","2020-12-14","2020-12-14","2021-08-20","2021-08-20","2021-08-20","2021-08-05"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","53885039310","ONETOUCH ","LANCETS","100","Select","Select",""],["","00054016625","MYCOPHENOLAT ","500MG","60","Select","Select",""],["","23155010401","METFORMIN ","1000MG","60","Select","Select",""],["","43547026810","ROPINIROLE ","0.25MG","60","Select","Select",""],["","00378827052","ALBUTEROL ","0.08%","75","Select","Select",""],["","70710113908","FLUCONAZOLE ","150MG","1","Select","Select",""],["","61314023710","CROMOLYN ","4% OP","10","Select","Select",""],["","59779044870","CVS ","21MG\/24H","30","Select","Select",""],["","00904549213","THERA-M ","","30","Select","Select",""],["","00093834401","GLYBURIDE ","5MG","30","Select","Select",""],["","70377000812","ROSUVASTATIN ","20MG","30","Select","Select",""],["","68382000301","AZATHIOPRINE ","50MG","30","Select","Select",""],["","50111033401","METRONIDAZOL ","500MG","14","Select","Select",""],["","00006027731","JANUVIA ","100MG","30","Select","Select",""],["","49702023113","TRIUMEQ ","","30","Select","Select",""],["","65862022801","LAMOTRIGINE ","100MG","60","Select","Select",""],["","57664013688","VITAMIN ","50000UNT","4","Select","Select",""],["","00536589688","NICOTINE ","21MG\/24H","28","Select","Select",""],["","00093816201","QUETIAPINE ","100MG","135","Select","Select",""],["","31722070130","LOSARTAN ","50MG","30","Select","Select",""],["","00169643810","LEVEMIR ","FLEXTOUC","30","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","00310653004","BYDUREON ","2MG","4","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","08290320122","BD  PEN NEEDL","32GX4MM","100","Select","Select",""],["","50428707945","SENNA ","8.6-50MG","30","Select","Select",""],["","00904645760","DOK ","100MG","30","Select","Select",""],["","10702001801","OXYCODONE ","5MG","10","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","30","Select","Select",""],["","43598075201","BUPROPION ","150MG SR","180","Select","Select",""],["","00169413212","OZEMPIC ","2\/1.5ML","2","Select","Select",""],["","00093768432","OLOPATADINE ","0.20%","5","Select","Select",""],["","57896030401","STOOL ","8.6-50MG","30","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","14","Select","Select",""],["","45802025735","MOMETASONE ","0.10%","15","Select","Select",""],["","00002143480","TRULICITY ","1.5\/0.5","2","Select","Select",""],["","00169406012","VICTOZA ","18MG\/3ML","9","Select","Select",""],["","08290305426","SHARPS ","5.4QT","1","Select","Select",""],["","69097015907","MELOXICAM ","15MG","30","Select","Select",""],["","65862022801","LAMOTRIGINE","100MG","60","Select","Select",""],["","57664013688","VITAMIN","50000UNT","4","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","1","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","14","Select","Select",""],["","53885099425","ONETOUCH","ULTRA BL","25","Select","Select",""],["","59779044870","CVS","21MG\/24H","30","Select","Select",""],["","00904549213","THERA-M","","30","Select","Select",""],["","70377000812","ROSUVASTATIN","20MG","30","Select","Select",""],["","00378827052","ALBUTEROL","0.08%","75","Select","Select",""],["","00093834401","GLYBURIDE","5MG","30","Select","Select",""],["","00006027731","JANUVIA","100MG","30","Select","Select",""],["","49702023113","TRIUMEQ","","30","Select","Select",""],["","68382000301","AZATHIOPRINE","50MG","30","Select","Select",""],["","00054016625","MYCOPHENOLAT","500MG","60","Select","Select",""],["","00169643810","LEVEMIR","FLEXTOUC","30","Select","Select",""],["","23155010401","METFORMIN","1000MG","60","Select","Select",""],["","43547026810","ROPINIROLE","0.25MG","60","Select","Select",""],["","00093816201","QUETIAPINE","100MG","135","Select","Select",""],["","61314023710","CROMOLYN","4% OP","10","Select","Select",""],["","00310653004","BYDUREON","2MG","4","Select","Select",""],["","67877032105","IBUPROFEN","800MG","30","Select","Select",""],["","10702001801","OXYCODONE","5MG","10","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","57896030401","STOOL","8.6-50MG","30","Select","Select",""],["","31722070130","LOSARTAN","50MG","30","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00904645760","DOK","100MG","30","Select","Select",""],["","45802025735","MOMETASONE","0.10%","15","Select","Select",""],["","08290320122","BD PEN NEEDL","32GX4MM","100","Select","Select",""],["","50428707945","SENNA","8.6-50MG","30","Select","Select",""],["","00002143480","TRULICITY","1.5\/0.5","2","Select","Select",""],["","00169413212","OZEMPIC","2\/1.5ML","4","Select","Select",""],["","43598075201","BUPROPION","150MG SR","180","Select","Select",""],["","00169406012","VICTOZA","18MG\/3ML","9","Select","Select",""],["","00093768432","OLOPATADINE","0.20%","5","Select","Select",""],["","08290305426","SHARPS","5.4QT","1","Select","Select",""],["","69097015907","MELOXICAM","15MG","30","Select","Select",""],["","00536589688","NICOTINE","21MG\/24H","28","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","14","Select","Select",""],["","63304069205","CLINDAMYCIN ","CAP 150MG","28","Select","Select",""],["","50111056001","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","00093226301","AMOXICILLIN ","TAB 500MG","30","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}