{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" NYLORACETOLEB W","gend":1,"add":"LODNAR 9184 # EVA HP","city":"CAPE CHARLES","state":"VA","zip":"23310-9998","dob":"1935-04-14","age":"","mstatus":"","insh":"10119430","cliId":"","pno":"3375771311","cno":"","email":"","ename":"","eno":"","pphy":"BALMORIA, SANDRA K","ppno":7578245676,"pcpadd":"5219 LANKFORD HIGHWAY","pcpcity":"NEW CHURCH","pcpstate":"VA","pcpzip":234153332,"pcpcounty":"","pcpid":"","pcpname":"BAYVIEW COMMUNITY HEALTH CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"Po Box 161","madd2":"","madd3":"","mcity":"Cheriton","mstate":"VA","mzip":"23316-0161","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","00003089421","ELIQUIS","TAB 5MG","60.00","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","TES LITE","100.00","Select","Select",""],["","67877049005","EZETIMIBE","TAB 10MG","90.00","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100.00","Select","Select",""],["","00713063415","MOMETASONE","CRE 0.001","15.00","Select","Select",""],["","00006011231","JANUVIA","TAB 50MG","30.00","Select","Select",""],["","31722070110","LOSARTAN","TAB 50MG","90.00","Select","Select",""],["","00456142030","BYSTOLIC","TAB 20MG","30.00","Select","Select",""],["","67877019910","AMLODIPINE","TAB 10MG","90.00","Select","Select",""],["","16729022516","SPIRONOLACT","TAB 25MG","60.00","Select","Select",""],["","00054429931","FUROSEMIDE","TAB 40MG","180.00","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","48.00","Select","Select",""],["","98302000100","SIMPLE","MIS LANCING","1.00","Select","Select",""],["","99073014002","FREESTYLE    LIQ CONTROL","LIQ CONTROL","1.00","Select","Select",""],["","98302000105","ALCOHOL","PAD ","100.00","Select","Select",""],["","99073070805","FREESTYLE    MIS LITE","MIS LITE","1.00","Select","Select",""],["","91237000148","EASY","TES BLD GLUC","50.00","Select","Select",""],["","21922000909","DICLOFENAC","GEL 0.01","100.00","Select","Select",""],["","70010000201","COLCHICINE","TAB 0.6MG","3.00","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":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"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":""}]}]}