{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARY E HARKLESS","gend":1,"add":"306 N NANSEMOND STREET","city":"RICHMOND","state":"VA","zip":"23221-2211","dob":"1940-09-20","age":"","mstatus":"","insh":"11000066","cliId":"","pno":8043430106,"cno":"","email":"","ename":"","eno":"","pphy":"DICKERSON, TASHA B","ppno":8042257177,"pcpadd":"304 E LEIGH ST","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":232191410,"pcpcounty":"","pcpid":"","pcpname":"DOMINION MEDICAL ASSOCIATES","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"APT B","add3":"","madd1":"306 N NANSEMOND STREET","madd2":"APT B","madd3":"","mcity":"RICHMOND","mstate":"VA","mzip":"23221-2211","pcpfaxno":"(804) 237-0362","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":[]},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","00310737020","BUDES\/FORMOT ","160-4.5","10.20","Select","Select",""],["","33342010215","MONTELUKAST ","10MG","30.00","Select","Select",""],["","67877019910","AMLODIPINE ","10MG","30.00","Select","Select",""],["","13668042905","PANTOPRAZOLE ","40MG","30.00","Select","Select",""],["","43547028111","ESCITALOPRAM ","10MG","30.00","Select","Select",""],["","70377000812","ROSUVASTATIN ","20MG","30.00","Select","Select",""],["","68180096301","ALBUTEROL ","HFA","8.50","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16.00","Select","Select",""],["","00597007541","SPIRIVA ","HANDIHLR","30.00","Select","Select",""],["","76385011350","CARVEDILOL ","25MG","60.00","Select","Select",""],["","64380073606","HYDRALAZINE ","100MG","90.00","Select","Select",""],["","24208046325","LATANOPROST ","0.01%","2.50","Select","Select",""],["","00955105027","SEVELAMER ","800MG","84.00","Select","Select",""],["","23155017801","ISOSORB ","60MG ER","30.00","Select","Select",""],["","69315011710","FUROSEMIDE ","40MG","45.00","Select","Select",""],["","00186037020","SYMBICORT ","160-4.5","10.20","Select","Select",""],["","65862001205","SERTRALINE ","50MG","30.00","Select","Select",""],["","61314001910","DORZOLAMIDE ","2% OP","10.00","Select","Select",""],["","76204060030","IPRATROPIUM\/ ","ALBUTER","360.00","Select","Select",""],["","67877022205","GABAPENTIN ","100MG","30.00","Select","Select",""],["","50742061610","METOPROL ","50MG ER","30.00","Select","Select",""],["","16714073501","ESOMEPRA ","20MG DR","30.00","Select","Select",""],["","10702000201","PROMETHAZINE ","12.5MG","14.00","Select","Select",""],["","43386005019","GAVILYTE-N ","FLAV PK","4,000.00","Select","Select",""],["","16714004112","ALLOPURINOL ","100MG","30.00","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","473.00","Select","Select",""],["","00065026005","TRAVATAN ","0.00%","5.00","Select","Select",""],["","10702001801","OXYCODONE ","5MG","30.00","Select","Select",""],["","59922063101","AURYXIA ","210MG","810.00","Select","Select",""],["","45802049383","AMMONIUM ","12%","280.00","Select","Select",""],["","00781572010","POT  CL MICRO","20MEQ ER","30.00","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","20.00","Select","Select",""],["","00591544301","PREDNISONE ","20MG","2.00","Select","Select",""],["","62135019122","CALC ","667MG","180.00","Select","Select",""],["","10572010001","PEG-3350 ","ELECTROL","4,000.00","Select","Select",""],["","70710113908","FLUCONAZOLE ","150MG","1.00","Select","Select",""],["","67877021905","CEPHALEXIN ","500MG","28.00","Select","Select",""],["","60505058604","OLOPATADINE ","0.20%","2.50","Select","Select",""],["","59310057922","PROAIR ","","8.50","Select","Select",""],["","00832046530","NYAMYC ","100000","30.00","Select","Select",""],["","68180016006","AZITHROMYCIN ","250MG","1.00","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":""}]}]}