{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BARBARA L SMALL","gend":1,"add":"6000 BROOK ROAD","city":"RICHMOND","state":"VA","zip":"23227-2289","dob":"1937-06-06","age":"","mstatus":"","insh":"11000493","cliId":"","pno":8042295883,"cno":"","email":"","ename":"","eno":"","pphy":"HABIB, SAIMA Z","ppno":8042543500,"pcpadd":"417 N 11th St","pcpcity":"Richmond","pcpstate":"VA","pcpzip":232985002,"pcpcounty":"","pcpid":"","pcpname":"MCV AMBULATORY CARE CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"APT 220","add3":"","madd1":"6000 BROOK ROAD","madd2":"APT 220","madd3":"","mcity":"RICHMOND","mstate":"VA","mzip":"23227-2289","pcpfaxno":"(804) 254-1616","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":[["","65162083366","DICLOFENAC ","1%","400.00","Select","Select",""],["","68180072103","AMLODIPINE ","10MG","90.00","Select","Select",""],["","16729018201","HYDROCHLOROT ","12.5MG","90.00","Select","Select",""],["","76385011250","CARVEDILOL ","12.5MG","180.00","Select","Select",""],["","24208046325","LATANOPROST ","0.01%","7.50","Select","Select",""],["","00955173730","LEFLUNOMIDE ","20MG","90.00","Select","Select",""],["","66993005702","HYDROXYCHLOR ","200MG","180.00","Select","Select",""],["","65862020290","LOSARTAN ","50MG","180.00","Select","Select",""],["","33342017910","OLMESA ","20MG","90.00","Select","Select",""],["","61314022615","TIMOLOL ","0.25% OP","15.00","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","48.00","Select","Select",""],["","69238126601","OSELTAMIVIR ","75MG","10.00","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":""}]}]}