{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"QUEENIE R TATE","gend":1,"add":"213 KNIGHTSMANOR COURT","city":"HENRICO","state":"VA","zip":"23227-3109","dob":"1965-01-30","age":"","mstatus":"","insh":"11001823","cliId":"","pno":8046773938,"cno":"","email":"","ename":"","eno":"","pphy":"LEMAY, MEGAN","ppno":8048287700,"pcpadd":"1250 E Marshall St","pcpcity":"Richmond","pcpstate":"VA","pcpzip":232985023,"pcpcounty":"","pcpid":"","pcpname":"MCV AMBULATORY CARE CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"HENRICO COUNTY","add3":"","madd1":"213 KNIGHTSMANOR COURT","madd2":"HENRICO COUNTY","madd3":"","mcity":"HENRICO","mstate":"VA","mzip":"23227-3109","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":[["","51991074890","DULOXETINE ","60MG","30.00","Select","Select",""],["","49483060350","IBUPROFEN ","600MG","10.00","Select","Select",""],["","50383077504","LIDOCAINE ","2% VISC","100.00","Select","Select",""],["","00093117410","PENICILLN ","500MG","28.00","Select","Select",""],["","00093317431","ALBUTEROL ","E","8.50","Select","Select",""],["","59310057922","PROAIR ","","8.50","Select","Select",""],["","00597007541","SPIRIVA ","HANDIHLR","30.00","Select","Select",""],["","00378064205","PREDNISONE ","20MG","10.00","Select","Select",""],["","61958250101","BIKTARVY ","","30.00","Select","Select",""],["","00006022761","ISENTRESS ","400MG","60.00","Select","Select",""],["","24208039915","IPRATROPIUM ","0.06%","45.00","Select","Select",""],["","65862050301","AMOX\/K ","875-125","19.00","Select","Select",""],["","53489011905","DOXYCYCL ","100MG","14.00","Select","Select",""],["","68180016006","AZITHROMYCIN ","250MG","30.00","Select","Select",""],["","43598029490","PREGABALIN ","100MG","70.00","Select","Select",""],["","62175061743","PANTOPRAZOLE ","40MG","30.00","Select","Select",""],["","61958070101","TRUVADA ","200-300","30.00","Select","Select",""],["","10702001801","OXYCODONE ","5MG","42.00","Select","Select",""],["","00173069600","ADVAIR ","250\/50","60.00","Select","Select",""],["","13107008405","LORAZEPAM ","1MG","2.00","Select","Select",""],["","60505614300","CEFAZOLIN ","10GM","5.00","Select","Select",""],["","66993058597","FLUTIC\/SALME ","250\/50","60.00","Select","Select",""],["","42858030201","HYDROMORPHON ","4MG","5.00","Select","Select",""],["","69097094312","GABAPENTIN ","300MG","90.00","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","473.00","Select","Select",""],["","53746010901","HYDROCO\/APAP ","5-325MG","5.00","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":""}]}]}