{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MAXINE F THOMPSON","gend":1,"add":"244 DRY BRANCH ROAD","city":"CHURCHVILLE","state":"VA","zip":"24421-2633","dob":"1938-04-24","age":"","mstatus":"","insh":"11002708","cliId":"","pno":5404481835,"cno":"","email":"","ename":"","eno":"","pphy":"TRAN, GEORGE M","ppno":5402139260,"pcpadd":"412 Namozine St","pcpcity":"Burkeville","pcpstate":"VA","pcpzip":239223184,"pcpcounty":"","pcpid":"","pcpname":"AUGUSTA HEALTH FAMILY PRACTICE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"244 DRY BRANCH ROAD","madd2":"","madd3":"","mcity":"CHURCHVILLE","mstate":"VA","mzip":"24421-2633","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":[["","13107008305","LORAZEPAM ","0.5MG","30.00","Select","Select",""],["","00193709021","CONTOUR ","BLD GLUC","100.00","Select","Select",""],["","73070010315","INSULIN ","FLEXPEN","15.00","Select","Select",""],["","70010049105","METFORMIN ","ORAL TAB","60.00","Select","Select",""],["","65862007601","CIPROFLOXACN ","250MG","20.00","Select","Select",""],["","00469260230","MYRBETRIQ ","50MG","30.00","Select","Select",""],["","16714061305","SERTRALINE ","100MG","30.00","Select","Select",""],["","60505257808","ATORVASTATIN ","10MG","30.00","Select","Select",""],["","00169633910","NOVOLOG ","FLEXPEN","15.00","Select","Select",""],["","66993068130","OLANZAPINE ","5MG","30.00","Select","Select",""],["","24979002806","DILTIAZEM ","240MG ER","60.00","Select","Select",""],["","68180098103","LISINOPRIL ","20MG","30.00","Select","Select",""],["","08290326895","BD ","SNGL USE","200.00","Select","Select",""],["","13668010390","DONEPEZIL ","10MG","90.00","Select","Select",""],["","00088221905","LANTUS ","100\/ML","15.00","Select","Select",""],["","08290320122","BD  PEN NEEDL","32GX4MM","360.00","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","14.00","Select","Select",""],["","62037059990","CARTIA ","240\/24HR","60.00","Select","Select",""],["","00169643810","LEVEMIR ","FLEXTOUC","15.00","Select","Select",""],["","67877025130","TRIAMCINOLON ","0.10%","60.00","Select","Select",""],["","45802046564","KETOCONAZOLE ","2%","120.00","Select","Select",""],["","08222440006","ULTICARE ","ALCOHOL","100.00","Select","Select",""],["","49348089610","SM ","PREP","200.00","Select","Select",""],["","49281040565","FLUZONE ","PF 19-20","0.50","Select","Select",""],["","68180022907","MEMANTINE ","HCL 5MG","90.00","Select","Select",""],["","00093101042","MUPIROCIN ","2%","22.00","Select","Select",""],["","68308015215","NYSTATIN ","100000","30.00","Select","Select",""],["","70461012103","FLUAD ","2021-22","0.50","Select","Select",""],["","70710113908","FLUCONAZOLE ","150MG","6.00","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":""}]}]}