{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CONNIE A SMITH","gend":1,"add":"1030 GERMAN SCHOOL RD","city":"RICHMOND","state":"VA","zip":"23224-9998","dob":"1966-05-19","age":"","mstatus":"","insh":"11002564","cliId":"","pno":8042975228,"cno":"","email":"","ename":"","eno":"","pphy":"RACKSON, KATHRYN","ppno":8042543500,"pcpadd":"2116 W Laburnum Ave Ste 100","pcpcity":"Richmond","pcpstate":"VA","pcpzip":232274359,"pcpcounty":"","pcpid":"","pcpname":"VCU CENTER FOR ADVANCED HEALTH","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"APT 112","add3":"","madd1":"1030 German School Rd Apt 104","madd2":"","madd3":"","mcity":"Richmond","mstate":"VA","mzip":"23225-4291","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":[["","59310057922","PROAIR ","","17.00","Select","Select",""],["","00173088710","TRELEGY ","ELLIPTA","60.00","Select","Select",""],["","00169633910","NOVOLOG ","FLEXPEN","15.00","Select","Select",""],["","67877041305","METFORMIN ","500MG ER","30.00","Select","Select",""],["","64597030160","NUEDEXTA ","20-10MG","30.00","Select","Select",""],["","68462039710","OMEPRAZOLE ","40MG","30.00","Select","Select",""],["","00555077902","MEDROXYPR ","10MG","26.00","Select","Select",""],["","00088221905","LANTUS ","100\/ML","15.00","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","LITE","100.00","Select","Select",""],["","00054429731","FUROSEMIDE ","20MG","30.00","Select","Select",""],["","50111091703","TORSEMIDE ","20MG","30.00","Select","Select",""],["","43547026910","ROPINIROLE ","0.5MG","30.00","Select","Select",""],["","68462016505","CARVEDILOL ","25MG","60.00","Select","Select",""],["","67877022405","GABAPENTIN ","400MG","120.00","Select","Select",""],["","86227012105","SURE ","31GX3\/16","100.00","Select","Select",""],["","65862035705","CLOPIDOGREL ","75MG","30.00","Select","Select",""],["","64380080308","RANITIDINE ","150MG","60.00","Select","Select",""],["","65862086001","FAMOTIDINE ","40MG","30.00","Select","Select",""],["","67877051305","ATORVASTATIN ","40MG","30.00","Select","Select",""],["","13668001005","CITALOPRAM ","20MG","30.00","Select","Select",""],["","00093317431","ALBUTEROL ","E","17.00","Select","Select",""],["","13668011390","LOSARTAN ","25MG","30.00","Select","Select",""],["","00002143480","TRULICITY ","1.5\/0.5","2.00","Select","Select",""],["","62175044231","POLYETH ","3350 NF","527.00","Select","Select",""],["","00378530501","ZOLPIDEM ","5MG","30.00","Select","Select",""],["","00487020103","IPRATROPIUM\/ ","ALBUTER","360.00","Select","Select",""],["","00228255011","DICLOFENAC ","50MG DR","30.00","Select","Select",""],["","00378064010","PREDNISONE ","5MG","5.00","Select","Select",""],["","00574402435","ERYTHROMYCIN ","5MG\/GM","3.50","Select","Select",""],["","64980051505","OFLOXACIN ","0.3% OP","5.00","Select","Select",""],["","61314063705","PREDNISOLONE ","1% OP","5.00","Select","Select",""],["","68180016011","AZITHROMYCIN ","250MG","6.00","Select","Select",""],["","53746046605","IBUPROFEN ","800MG","21.00","Select","Select",""],["","57237003105","AMOXICILLIN ","500MG","21.00","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16.00","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","",""],[""],[""],[""],[""]],"comment":[["","",""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}