{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"THERESA NOBLE","gend":1,"add":"2002 MANSION AVE","city":"RICHMOND","state":"VA","zip":"23224-9998","dob":"1960-04-06","age":"","mstatus":"","insh":"11001981","cliId":"","pno":8042534421,"cno":"","email":"","ename":"","eno":"","pphy":"CLARK, RALPH R","ppno":8048289357,"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":"","add3":"","madd1":"2002 MANSION AVE","madd2":"","madd3":"","mcity":"RICHMOND","mstate":"VA","mzip":"23224-9998","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":[["","17478071510","BRIMONIDINE ","0.2% OP","5.00","Select","Select",""],["","00173069600","ADVAIR ","250\/50","60.00","Select","Select",""],["","00093317431","ALBUTEROL ","E","42.50","Select","Select",""],["","73070010315","INSULIN ","FLEXPEN","15.00","Select","Select",""],["","00169633910","NOVOLOG ","FLEXPEN","15.00","Select","Select",""],["","00169406013","VICTOZA ","18MG\/3ML","9.00","Select","Select",""],["","59762033302","LATANOPROST ","0.01%","2.50","Select","Select",""],["","68180051703","LISINOPRIL ","40MG","90.00","Select","Select",""],["","00193731221","CONTOUR ","NEXT","200.00","Select","Select",""],["","00591544305","PREDNISONE ","20MG","6.00","Select","Select",""],["","51672128202","TRIAMCINOLON ","0.10%","30.00","Select","Select",""],["","98302000105","ALCOHOL ","","200.00","Select","Select",""],["","00088221905","LANTUS ","100\/ML","15.00","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","SENSOR","2.00","Select","Select",""],["","98302000160","ULTRA ","31G","200.00","Select","Select",""],["","16714087601","ATORVASTATIN ","40MG","90.00","Select","Select",""],["","98302001430","COMFORT ","31GX5MM","200.00","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","70.00","Select","Select",""],["","69238126601","OSELTAMIVIR ","75MG","10.00","Select","Select",""],["","53885097301","ONETOUCH ","LANC DEV","1.00","Select","Select",""],["","67877056105","METFORMIN ","500MG","180.00","Select","Select",""],["","64980030301","CHLORTHALID ","25MG","90.00","Select","Select",""],["","65162083366","DICLOFENAC ","1%","700.00","Select","Select",""],["","65862057490","MONTELUKAST ","10MG","90.00","Select","Select",""],["","98302000100","SIMPLE ","LANCING","1.00","Select","Select",""],["","52817033010","CYCLOBENZAPR ","5MG","30.00","Select","Select",""],["","76204060030","IPRATROPIUM\/ ","ALBUTER","90.00","Select","Select",""],["","69547035302","NARCAN ","","2.00","Select","Select",""],["","59310057922","PROAIR ","","25.50","Select","Select",""],["","00054004544","IPRATROPIUM ","0.03%","30.00","Select","Select",""],["","65162062711","TRAMADOL ","50MG","45.00","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","48.00","Select","Select",""],["","57599157904","FREESTYLE    TES PREC NEO","PREC NEO","100.00","Select","Select",""],["","27241009803","DULOXETINE ","30MG","60.00","Select","Select",""],["","10702000350","PROMETHAZINE ","25MG","12.00","Select","Select",""],["","43598029490","PREGABALIN ","100MG","60.00","Select","Select",""],["","00193658621","MICROLET ","LANCETS","200.00","Select","Select",""],["","70010075401","METHOCARBAM ","500MG","20.00","Select","Select",""],["","23155050105","HYDROXYZ ","25MG","40.00","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","READER","1.00","Select","Select",""],["","08290320550","BD  PEN NEEDL","32GX5\/32","100.00","Select","Select",""],["","68462010530","ONDANSETRON ","4MG","10.00","Select","Select",""],["","65162010150","GABAPENTIN ","100MG","60.00","Select","Select",""],["","00143980305","DOXYCYCL ","100MG","14.00","Select","Select",""],["","13811071910","NITROFURANTN ","100MG","10.00","Select","Select",""],["","00071101568","LYRICA ","100MG","60.00","Select","Select",""],["","68462019005","NAPROXEN ","500MG","14.00","Select","Select",""],["","00093101042","MUPIROCIN ","2%","22.00","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":""}]}]}