{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DARLENE T HENSON","gend":1,"add":"215 HENSON BONNIE RD","city":"MINERAL","state":"VA","zip":"23117-9998","dob":"1955-03-31","age":"","mstatus":"","insh":"11003663","cliId":"","pno":5408944307,"cno":"","email":"","ename":"","eno":"","pphy":"WESTFIELD, WENDY K","ppno":5409672011,"pcpadd":"112 Crofton Pl Ste A","pcpcity":"Palmyra","pcpstate":"VA","pcpzip":229633363,"pcpcounty":"","pcpid":"","pcpname":"UVA PRIMARY AND SPECIALITY CARE ZIONS CROSS","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"PO. BOX 154","madd2":"","madd3":"","mcity":"MINERAL","mstate":"VA","mzip":"23117-9998","pcpfaxno":"(540) 967-2982","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":[["","70377000812","ROSUVASTATIN ","20MG","90.00","Select","Select",""],["","68382076010","METFORMIN ","1000MG","90.00","Select","Select",""],["","65162019050","NAPROXEN ","500MG","60.00","Select","Select",""],["","49702023113","TRIUMEQ ","","30.00","Select","Select",""],["","00168020230","CLINDAMYCIN ","1%","30.00","Select","Select",""],["","61958250101","BIKTARVY ","","30.00","Select","Select",""],["","47335089374","TEMOZOLOMIDE ","250MG","5.00","Select","Select",""],["","69097052444","DICLOFENAC ","1%","100.00","Select","Select",""],["","00093005805","TRAMADOL ","50MG","28.00","Select","Select",""],["","00054051741","MORPHINE ","100\/5ML","30.00","Select","Select",""],["","00054353244","LORAZEPAM ","2MG\/ML","30.00","Select","Select",""],["","68382097001","CHLORTHALID ","25MG","90.00","Select","Select",""],["","59310057922","PROAIR ","","8.50","Select","Select",""],["","65862018830","ONDANSETRON ","8MG","20.00","Select","Select",""],["","67877021660","CEFUROXIME ","500MG","14.00","Select","Select",""],["","60432053716","NYSTATIN ","100000","140.00","Select","Select",""],["","43547039910","CYCLOBENZAPR ","5MG","20.00","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","6.00","Select","Select",""],["","60505025203","TIZANIDINE ","4MG","30.00","Select","Select",""],["","53746010901","HYDROCO\/APAP ","5-325MG","30.00","Select","Select",""],["","70710114003","FLUCONAZOLE ","200MG","15.00","Select","Select",""],["","16571066401","METRONIDAZOL ","500MG","21.00","Select","Select",""],["","53885004601","ONETOUCH ","ULTRA 2","1.00","Select","Select",""],["","52565000730","LIDO\/PRILOCN ","2.5-2.5%","30.00","Select","Select",""],["","43386019430","POT  CHLORIDE","20MEQ","30.00","Select","Select",""],["","59746011506","PROCHLORPER ","10MG","30.00","Select","Select",""],["","62332000191","FAMOTIDINE ","20MG","180.00","Select","Select",""],["","59746017310","PREDNISONE ","10MG","8.00","Select","Select",""],["","59746012106","MECLIZINE ","25MG","25.00","Select","Select",""],["","50111078751","AZITHROMYCIN ","250MG","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":""}]}]}