{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALICE VENNING-BLAKE","gend":1,"add":"3396 FRANKLIN TPKE","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"1969-03-26","age":"","mstatus":"","insh":"2052581*01","cliId":"","pno":"843\/568-0354","cno":"843\/568-0354","email":"","ename":"","eno":"","pphy":"HUNDLEY, SUSAN DUPUY MD","ppno":"434\/738-6420","pcpadd":"380 WASHINGTON STREET","pcpcity":"BOYDTON","pcpstate":"VA","pcpzip":23917,"pcpcounty":"","pcpid":125561,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/738-6054","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R06.02","Z86.711","Z86.73","Z86.718","R06.09","R06.2","G47.34","R26.89","G43.009","E66.9","G40.219","R11.0","K21.9","R10.30","R19.7","R13.10","M25.562","R93.5","R10.11","Z80.0","M25.60","R94.5","K75.81","K42.9","N83.202","R10.32","R07.89","K44.9","G47.30","E11.9","M79.602","S16.1XXA","M54.12","V89.2XXA","I10.","M79.601","M47.22","M79.7","M13.0","M17.12","Z12.11","K59.00","K31.84","M76.822","G89.29","R07.9","Z88.2","Z79.01","E11.65","E78.2","Z76.89","G47.33","G47.10","R06.83","J96.01","I20.9","S16.1XXD","R10.13","NO DATA","Z11.59","G89.4","M54.5","D25.9","M75.52","E78.5","R76.8","G43.909","J45.909","G56.00","E55.9","G62.9","E66.3","M65.4","N83.209","D50.9","T18.128A","J69.0","I82.411","I82.441","I82.813","Z13.820","G56.01","Z98.890","Z79.891","Z79.899","Z47.89","Z48.89"],"date":["2021-04-12","2021-03-16","2021-04-12","2021-04-12","2021-03-16","2021-03-16","2021-10-08","2021-09-29","2021-09-29","2021-09-29","2021-04-12","2021-08-02","2021-08-02","2021-08-02","2021-04-21","2021-08-02","2021-05-06","2020-09-23","2020-08-26","2021-07-09","2020-08-26","2020-08-26","2020-09-23","2021-01-08","2020-12-14","2020-11-03","2020-11-03","2021-02-15","2021-04-12","2021-01-29","2021-02-24","2020-12-28","2020-12-28","2020-12-28","2021-01-29","2021-05-17","2021-05-25","2021-09-08","2021-05-27","2021-05-27","2021-07-09","2021-08-02","2021-08-02","2020-06-01","2021-09-29","2020-09-21","2021-04-03","2021-04-03","2021-02-01","2020-09-21","2020-04-30","2020-05-26","2020-12-29","2020-12-29","2021-02-01","2021-02-01","2021-02-24","2021-01-29","2021-02-15","2021-02-15","2021-05-25","2021-05-25","2020-12-23","2020-12-18","2020-12-18","2020-12-18","2020-12-18","2020-12-18","2020-12-18","2020-12-18","2020-12-18","2020-12-18","2020-12-18","2020-12-23","2021-01-29","2021-01-29","2021-01-31","2021-01-31","2021-01-31","2021-01-31","2021-07-27","2021-08-26","2021-10-22","2021-09-08","2021-09-08","2021-10-22","2021-10-22"],"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":[["","00378064110","PREDNISONE ","10MG","30","Select","Select",""],["","55111015810","OMEPRAZOLE ","20MG","120","Select","Select",""],["","70710122701","AMITRIPTYLIN ","50MG","60","Select","Select",""],["","68382002310","ATENOLOL ","50MG","90","Select","Select",""],["","65862024608","LEVETIRACETA ","500MG","120","Select","Select",""],["","43598029490","PREGABALIN ","100MG","60","Select","Select",""],["","69097086107","ZONISAMIDE ","100MG","60","Select","Select",""],["","00093738201","VENLAFAXINE ","75MG","60","Select","Select",""],["","65862086001","FAMOTIDINE ","40MG","30","Select","Select",""],["","00591565810","CYCLOBENZAPR ","10MG","30","Select","Select",""],["","65862018730","ONDANSETRON ","4MG","30","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","50428054089","CVS ","5000UNIT","30","Select","Select",""],["","00006027731","JANUVIA ","100MG","30","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","00002143611","EMGALITY ","120MG\/ML","1","Select","Select",""],["","55111029236","SUMATRIPTAN ","50MG","10","Select","Select",""],["","16571020106","DICLOFENAC ","75MG DR","60","Select","Select",""],["","53885000810","ONETOUCH ","PLUS 33G","100","Select","Select",""],["","43547026810","ROPINIROLE ","0.25MG","60","Select","Select",""],["","65162006205","SUCRALFATE ","1GM\/10ML","600","Select","Select",""],["","63481068447","VOLTAREN ","1%","100","Select","Select",""],["","00143312601","DICYCLOMINE ","10MG","90","Select","Select",""],["","90166001334","LANCETS ","33G","100","Select","Select",""],["","68180098003","LISINOPRIL ","10MG","3","Select","Select",""],["","00093716456","TOLTERODINE ","4MG ER","90","Select","Select",""],["","68180046707","LOVASTATIN ","10MG","30","Select","Select",""],["","50428057523","VITAMIN ","5000UNIT","30","Select","Select",""],["","00093005805","TRAMADOL ","50MG","20","Select","Select",""],["","60505025203","TIZANIDINE ","4MG","270","Select","Select",""],["","62175061846","PANTOPRAZOLE ","20MG","180","Select","Select",""],["","24208091055","ERYTHROMYCIN ","5MG\/GM","4","Select","Select",""],["","68382025501","OXYBUTYNIN ","5MG ER","90","Select","Select",""],["","50428209452","MAG ","LEMON","296","Select","Select",""],["","69097015907","MELOXICAM ","15MG","90","Select","Select",""],["","00603188016","LIDOCAINE ","5%","5","Select","Select",""],["","49483060450","IBUPROFEN ","800MG","30","Select","Select",""],["","55111032001","GLIMEPIRIDE ","1MG","30","Select","Select",""],["","71093014005","METHOCARBAM ","500MG","20","Select","Select",""],["","27808003501","HYDROCO\/APAP ","5-325MG","10","Select","Select",""],["","69266000048","IBGARD ","90MG","144","Select","Select",""],["","65862052305","GABAPENTIN ","600MG","90","Select","Select",""],["","00003089421","ELIQUIS ","5MG","60","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","00245003660","PREVALITE ","4GM PK","180","Select","Select",""],["","31604002683","D3 ","1000UNIT","30","Select","Select",""],["","65862086001","FAMOTIDINE","40MG","30","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","120","Select","Select",""],["","65862024608","LEVETIRACETA","500MG","120","Select","Select",""],["","70710122701","AMITRIPTYLIN","50MG","60","Select","Select",""],["","00093738201","VENLAFAXINE","75MG","60","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","50428054089","CVS","5000UNIT","30","Select","Select",""],["","43598029490","PREGABALIN","100MG","60","Select","Select",""],["","69097086107","ZONISAMIDE","100MG","60","Select","Select",""],["","00591565810","CYCLOBENZAPR","10MG","30","Select","Select",""],["","65862018730","ONDANSETRON","4MG","30","Select","Select",""],["","68382002310","ATENOLOL","50MG","90","Select","Select",""],["","55111029236","SUMATRIPTAN","50MG","10","Select","Select",""],["","16571020106","DICLOFENAC","75MG DR","60","Select","Select",""],["","00378064110","PREDNISONE","10MG","30","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","63481068447","VOLTAREN","1%","100","Select","Select",""],["","68180046707","LOVASTATIN","10MG","30","Select","Select",""],["","00006027731","JANUVIA","100MG","30","Select","Select",""],["","53885013610","ONETOUCH","LANCETS","100","Select","Select",""],["","50428057523","VITAMIN","5000UNIT","30","Select","Select",""],["","90166001334","LANCETS","33G","100","Select","Select",""],["","00002143611","EMGALITY","120MG\/ML","1","Select","Select",""],["","69097015907","MELOXICAM","15MG","90","Select","Select",""],["","00143312601","DICYCLOMINE","10MG","90","Select","Select",""],["","43547026810","ROPINIROLE","0.25MG","60","Select","Select",""],["","50428209452","MAG","LEMON","296","Select","Select",""],["","55111032001","GLIMEPIRIDE","1MG","30","Select","Select",""],["","65162006205","SUCRALFATE","1GM\/10ML","600","Select","Select",""],["","69266000048","IBGARD","90MG","144","Select","Select",""],["","68180098003","LISINOPRIL","10MG","30","Select","Select",""],["","00093716456","TOLTERODINE","4MG ER","90","Select","Select",""],["","68382025501","OXYBUTYNIN","5MG ER","90","Select","Select",""],["","00093005805","TRAMADOL","50MG","90","Select","Select",""],["","00003089421","ELIQUIS","5MG","75","Select","Select",""],["","60505025203","TIZANIDINE","4MG","270","Select","Select",""],["","62175061846","PANTOPRAZOLE","20MG","180","Select","Select",""],["","24208091055","ERYTHROMYCIN","5MG\/GM","4","Select","Select",""],["","00245003660","PREVALITE","4GM PK","180","Select","Select",""],["","00603188016","LIDOCAINE","5%","5","Select","Select",""],["","49483060450","IBUPROFEN","800MG","30","Select","Select",""],["","31604002683","D3","1000UNIT","30","Select","Select",""],["","65862052305","GABAPENTIN","600MG","90","Select","Select",""],["","27808003501","HYDROCO\/APAP","5-325MG","10","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","67877026218","RIZATRIPTAN","10MG","12","Select","Select",""],["","71093014005","METHOCARBAM","500MG","20","Select","Select",""],["","67877026218","RIZATRIPTAN ","TAB 10MG","12","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","20","Select","Select",""],["","00173086910","ANORO ","AER 62.5-25","60","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":""}]}]}