{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TANYA   F WHETZEL","gend":1,"add":"10931 S JAMES MADISON HWY","city":"DILLWYN","state":"VA","zip":"23936-9998","dob":"1972-06-07","age":"","mstatus":"","insh":"20039813*01","cliId":"","pno":"434\/414-5077","cno":"434\/414-5077","email":"","ename":"","eno":"","pphy":"BASHORE, RANDALL T MD","ppno":"434\/581-3271","pcpadd":"RT 15 SOUTH","pcpcity":"NEW CANTON","pcpstate":"VA","pcpzip":23123,"pcpcounty":"","pcpid":105792,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"434\/390-8605","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J32.9","B96.89","J44.1","R06.02","R50.9","R53.1","R05.","J02.0","J02.9","J98.8","E66.01","J45.909","J06.9","J40.","L73.2","H47.239","S20.212A","T71.9XXA","F17.229","Y04.8XXA","Z11.52","R52.","H65.193","Z23.","R06.83","B37.3","Z11.59"],"date":["2020-02-07","2020-01-17","2020-01-17","2020-04-27","2020-04-27","2020-04-27","2020-04-27","2020-01-29","2021-01-18","2020-04-27","2020-04-27","2020-04-27","2020-05-01","2021-11-15","2020-01-10","2020-01-10","2020-11-26","2020-11-26","2020-11-26","2020-11-26","2021-01-18","2021-01-18","2020-01-02","2020-01-02","2020-02-07","2020-02-07","2021-11-15"],"priorHcc":["","","","","","","","","","","","","",null,"","","","","","","","","","","","",null]}},{"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":[["","50111078751","AZITHROMYCIN ","250MG","6","Select","Select",""],["","00085113204","PROVENTIL ","HFA","7","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","00121077504","GG\/CODEINE ","100-10\/5","200","Select","Select",""],["","00603533821","PREDNISONE ","10MG","18","Select","Select",""],["","67877031901","IBUPROFEN ","400MG","21","Select","Select",""],["","00093227534","AMOX\/K ","875-125","14","Select","Select",""],["","53746010901","HYDROCO\/APAP ","5-325MG","12","Select","Select",""],["","65862001501","AMOXICILLIN ","875MG","20","Select","Select",""],["","70000016201","ALLERGY ","D-24","5","Select","Select",""],["","68462010430","FLUCONAZOLE ","200MG","5","Select","Select",""],["","53885059501","ONETOUCH ","30G","100","Select","Select",""],["","00527169501","BUT\/APAP\/CAF ","","20","Select","Select",""],["","51224001060","BENZONATATE ","100MG","30","Select","Select",""],["","58657050016","CODEINE\/GG ","10-100\/5","210","Select","Select",""],["","00093001006","TOLTERODINE ","1MG","60","Select","Select",""],["","00173085910","BREO ","100-25","180","Select","Select",""],["","00904671772","CETIRIZINE ","10MG","90","Select","Select",""],["","69097017353","IPRATROPIUM\/ ","ALBUTER","360","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","48","Select","Select",""],["","13668008190","MONTELUKAST ","10MG","90","Select","Select",""],["","00085720601","DULERA ","100-5MCG","39","Select","Select",""],["","43547028110","ESCITALOPRAM ","10MG","30","Select","Select",""],["","65162083366","DICLOFENAC ","1%","100","Select","Select",""],["","10702000310","PROMETHAZINE ","25MG","30","Select","Select",""],["","70010077001","METHOCARBAM ","750MG","42","Select","Select",""],["","64380073706","VITAMIN ","50000UNT","12","Select","Select",""],["","00049350079","DIFLUCAN ","150MG","2","Select","Select",""],["","59762015601","ATORVASTATIN ","20MG","60","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","70000016201","ALLERGY","D-24","5","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","50111078751","AZITHROMYCIN","250MG","6","Select","Select",""],["","00085113204","PROVENTIL","HFA","7","Select","Select",""],["","00121077504","GG\/CODEINE","100-10\/5","200","Select","Select",""],["","00603533821","PREDNISONE","10MG","18","Select","Select",""],["","67877031901","IBUPROFEN","400MG","21","Select","Select",""],["","00093227534","AMOX\/K","875-125","14","Select","Select",""],["","65862001501","AMOXICILLIN","875MG","20","Select","Select",""],["","68462010430","FLUCONAZOLE","200MG","5","Select","Select",""],["","53746010901","HYDROCO\/APAP","5-325MG","12","Select","Select",""],["","00527169501","BUT\/APAP\/CAF","","20","Select","Select",""],["","51224001060","BENZONATATE","100MG","30","Select","Select",""],["","58657050016","CODEINE\/GG","10-100\/5","210","Select","Select",""],["","53885059501","ONETOUCH","30G","100","Select","Select",""],["","00173085910","BREO","100-25","180","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","48","Select","Select",""],["","13668008190","MONTELUKAST","10MG","90","Select","Select",""],["","00085720601","DULERA","100-5MCG","39","Select","Select",""],["","00904671772","CETIRIZINE","10MG","90","Select","Select",""],["","69097017353","IPRATROPIUM\/","ALBUTER","360","Select","Select",""],["","43547028110","ESCITALOPRAM","10MG","30","Select","Select",""],["","16571012606","TOLTERODINE","1MG","60","Select","Select",""],["","10702000310","PROMETHAZINE","25MG","30","Select","Select",""],["","70010077001","METHOCARBAM","750MG","42","Select","Select",""],["","65162083366","DICLOFENAC","1%","100","Select","Select",""],["","59762015601","ATORVASTATIN","20MG","60","Select","Select",""],["","00049350079","DIFLUCAN","150MG","2","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","64380073706","VITAMIN","50000UNT","12","Select","Select",""],["","59310057922","PROAIR ","AER ","8","Select","Select",""],["","00143980350","DOXYCYCL ","CAP 100MG","20","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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}