{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PEDRO T RAMIREZ-BORNIA","gend":0,"add":"7000 AUBURN AVENUE","city":"NORFOLK","state":"VA","zip":"23513-1131","dob":"1949-03-07","age":"","mstatus":"","insh":"11001562","cliId":"","pno":7572010869,"cno":"","email":"","ename":"","eno":"","pphy":"HAMBAZ, NASSER","ppno":7576717777,"pcpadd":"4876 Baxter Rd","pcpcity":"Virginia Beach","pcpstate":"VA","pcpzip":234624404,"pcpcounty":"","pcpid":"","pcpname":"NORVIEW FAMILY PRACTICE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"APARTMENT 726","add3":"","madd1":"7000 AUBURN AVENUE","madd2":"APARTMENT 726","madd3":"","mcity":"NORFOLK","mstate":"VA","mzip":"23513-1131","pcpfaxno":7578537377,"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":[["","43386035701","HYDROCO\/APAP ","7.5-325","90.00","Select","Select",""],["","00597002402","COMBIVENT ","20-100","12.00","Select","Select",""],["","50228046501","NABUMETONE ","500MG","60.00","Select","Select",""],["","65862001501","AMOXICILLIN ","875MG","28.00","Select","Select",""],["","00173088710","TRELEGY ","ELLIPTA","180.00","Select","Select",""],["","00378827052","ALBUTEROL ","0.08%","375.00","Select","Select",""],["","69097012815","AMLODIPINE ","10MG","90.00","Select","Select",""],["","60505265601","TRIAMT\/HCTZ ","37.5-25","90.00","Select","Select",""],["","00781502207","METHYLPRED ","4MG","21.00","Select","Select",""],["","57237010099","METOPROL ","25MG","120.00","Select","Select",""],["","65862035790","CLOPIDOGREL ","75MG","90.00","Select","Select",""],["","69097052444","DICLOFENAC ","1%","700.00","Select","Select",""],["","00173088210","BREO ","200-25","180.00","Select","Select",""],["","00378064205","PREDNISONE ","20MG","15.00","Select","Select",""],["","68180051701","LISINOPRIL ","40MG","90.00","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","30.00","Select","Select",""],["","45802005535","TRIAMCINOLON ","0.10%","15.00","Select","Select",""],["","70377000415","SIMVASTATIN ","40MG","90.00","Select","Select",""],["","57237001830","DULOXETINE ","30MG","30.00","Select","Select",""],["","60758011905","PREDNISOLONE ","1% OP","5.00","Select","Select",""],["","63304061650","DOXYCYC ","100MG","14.00","Select","Select",""],["","60505258009","ATORVASTATIN ","40MG","90.00","Select","Select",""],["","65862085901","FAMOTIDINE ","20MG","28.00","Select","Select",""],["","65862050320","AMOX\/K ","875-125","14.00","Select","Select",""],["","65162089129","MOMETASONE ","50MCG","51.00","Select","Select",""],["","57237004101","PENICILLN ","500MG","20.00","Select","Select",""],["","58160081912","SHINGRIX ","50MCG","1.00","Select","Select",""],["","50111078810","AZITHROMYCIN ","500MG","10.00","Select","Select",""],["","59310057922","PROAIR ","","8.50","Select","Select",""],["","69547035302","NARCAN ","","2.00","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":""}]}]}