{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHIRLEY L VALENTINE","gend":1,"add":"11701 CHESTER VILLAGE DRIVE","city":"CHESTER","state":"VA","zip":"23831-1965","dob":"1937-02-16","age":"","mstatus":"","insh":"11000745","cliId":"","pno":8046214473,"cno":"","email":"","ename":"","eno":"","pphy":"FORTH, MONICA J","ppno":8047641253,"pcpadd":"8220 Meadowbridge Rd Ste 203","pcpcity":"Mechanicsville","pcpstate":"VA","pcpzip":231162339,"pcpcounty":"","pcpid":"","pcpname":"PRIMARY HEALTH GROUP","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"APARTMENT 222","add3":"","madd1":"11701 CHESTER VILLAGE DRIVE","madd2":"APARTMENT 222","madd3":"","mcity":"CHESTER","mstate":"VA","mzip":"23831-1965","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":[]},{"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":[["","00245021211","MIDODRINE ","5MG","90.00","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","LANCETS","300.00","Select","Select",""],["","69238149001","BUMETANIDE ","1MG","60.00","Select","Select",""],["","08222710031","PEN  NEEDLES  ","32GX4MM","100.00","Select","Select",""],["","43386033001","TRIMETHOPRIM ","100MG","30.00","Select","Select",""],["","57237001830","DULOXETINE ","30MG","30.00","Select","Select",""],["","59310057922","PROAIR ","","8.50","Select","Select",""],["","68382009505","CARVEDILOL ","25MG","60.00","Select","Select",""],["","16714087603","ATORVASTATIN ","40MG","30.00","Select","Select",""],["","00173088210","BREO ","200-25","60.00","Select","Select",""],["","00078077720","ENTRESTO ","49-51MG","60.00","Select","Select",""],["","00023916360","RESTASIS ","0.05%","60.00","Select","Select",""],["","13668010601","ISOSORB ","120MG ER","30.00","Select","Select",""],["","00469260230","MYRBETRIQ ","50MG","30.00","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","LITE","100.00","Select","Select",""],["","62175061746","PANTOPRAZOLE ","40MG","30.00","Select","Select",""],["","00173087610","ARNUITY ","200MCG","30.00","Select","Select",""],["","13811071910","NITROFURANTN ","100MG","10.00","Select","Select",""],["","65162010150","GABAPENTIN ","100MG","30.00","Select","Select",""],["","00487950160","ALBUTEROL ","0.08%","540.00","Select","Select",""],["","64764091830","ULORIC ","40MG","30.00","Select","Select",""],["","00093101042","MUPIROCIN ","2%","22.00","Select","Select",""],["","57599080000","FREESTY ","2 SENSOR","1.00","Select","Select",""],["","00088221905","LANTUS ","100\/ML","45.00","Select","Select",""],["","00169633910","NOVOLOG ","FLEXPEN","108.00","Select","Select",""],["","76204060060","IPRATROPIUM\/ ","ALBUTER","360.00","Select","Select",""],["","00591544210","PREDNISONE ","10MG","30.00","Select","Select",""],["","98302000100","SIMPLE ","LANCING","1.00","Select","Select",""],["","16714049602","CLOTRIM\/BETA ","1-0.05%","45.00","Select","Select",""],["","00093540189","OMEGA-3-ACID ","1GM","90.00","Select","Select",""],["","99073070432","FREESTYLE    LIQ CONTROL","CONTROL","1.00","Select","Select",""],["","68180037803","LOSARTAN ","100MG","30.00","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","24.00","Select","Select",""],["","73070010315","INSULIN ","FLEXPEN","75.00","Select","Select",""],["","51672130005","AMMONIUM ","12%","225.00","Select","Select",""],["","98302000160","ULTRA ","31G","300.00","Select","Select",""],["","08290320122","BD  PEN NEEDL","32GX4MM","100.00","Select","Select",""],["","98302000105","ALCOHOL ","","300.00","Select","Select",""],["","00093005301","BUSPIRONE ","5MG","90.00","Select","Select",""],["","00143980305","DOXYCYCL ","100MG","14.00","Select","Select",""],["","00597015561","STIOLTO ","2.5-2.5","4.00","Select","Select",""],["","67877021620","CEFUROXIME ","500MG","10.00","Select","Select",""],["","00378001805","METOPROL ","25MG","2.00","Select","Select",""],["","55111012701","CIPROFLOXACN ","500MG","10.00","Select","Select",""],["","59762219801","AZITHROMYCIN ","250MG","6.00","Select","Select",""],["","65162062711","TRAMADOL ","50MG","9.00","Select","Select",""],["","33342006510","VALSARTAN ","320MG","30.00","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","1.00","Select","Select",""],["","53746051105","SPIRONOLACT ","25MG","90.00","Select","Select",""],["","99073070805","FREESTYLE    MIS LITE","LITE","1.00","Select","Select",""],["","23155050105","HYDROXYZ ","25MG","30.00","Select","Select",""],["","45802088094","NYSTAT\/TRIAM ","","30.00","Select","Select",""],["","76204010025","IPRATROPIUM ","0.02%INH","62.50","Select","Select",""],["","57237000430","FLUCONAZOLE ","100MG","7.00","Select","Select",""],["","50484001030","SANTYL ","250\/GM","30.00","Select","Select",""],["","68382059516","DILTIAZEM ","120MG ER","30.00","Select","Select",""],["","65862050220","AMOX\/K ","500-125","14.00","Select","Select",""],["","65862053650","LEVOFLOXACIN ","250MG","5.00","Select","Select",""],["","98302000198","COMFORT ","31GX8MM","300.00","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":""}]}]}