{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHHO INN","gend":1,"add":"1626 KNOLLWOOD DR","city":"NORTH CHESTERFIELD","state":"VA","zip":"23235-9998","dob":"1939-06-25","age":"","mstatus":"","insh":"11004092","cliId":"","pno":8045255413,"cno":8046159856,"email":"","ename":"","eno":"","pphy":"VCU CENTER FOR ADVANCED HEALTH","ppno":8042543500,"pcpadd":"MCV Physicians 2116 W Laburnum Ave Ste 100","pcpcity":"Richmond","pcpstate":"VA","pcpzip":232274359,"pcpcounty":"","pcpid":"","pcpname":"VCU CENTER FOR ADVANCED HEALTH-SL","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1626 KNOLLWOOD DR","madd2":"","madd3":"","mcity":"NORTH CHESTERFIELD","mstate":"VA","mzip":"23235-9998","pcpfaxno":"(804) 254-1616","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["ASIAN\/PACIFIC"]],"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":[["","00143312601","DICYCLOMINE ","10MG","12.00","Select","Select",""],["","00093317431","ALBUTEROL ","E","8.50","Select","Select",""],["","00093768432","OLOPATADINE ","0.20%","2.50","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","90.00","Select","Select",""],["","00093083205","CLONAZEPAM ","0.5MG","30.00","Select","Select",""],["","10631040701","PROCTOSOL ","2.50%","28.35","Select","Select",""],["","00093005805","TRAMADOL ","50MG","30.00","Select","Select",""],["","62175018046","PANTOPRAZOLE ","20MG","90.00","Select","Select",""],["","55111015810","OMEPRAZOLE ","20MG","90.00","Select","Select",""],["","65862032904","ALENDRONATE ","70MG","12.00","Select","Select",""],["","65162044210","MECLIZINE ","25MG","30.00","Select","Select",""],["","62559043130","HYDROCORTISO ","2.50%","30.00","Select","Select",""],["","70377002811","ATORVASTATIN ","20MG","90.00","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","48.00","Select","Select",""],["","70461012103","FLUAD ","2021-22","0.50","Select","Select",""],["","24208063562","NEO\/POLY\/HC ","1% OTIC","10.00","Select","Select",""],["","16571020106","DICLOFENAC ","75MG DR","60.00","Select","Select",""],["","59310057922","PROAIR ","","8.50","Select","Select",""],["","70710113908","FLUCONAZOLE ","150MG","1.00","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","14.00","Select","Select",""],["","51672126302","NYSTAT\/TRIAM ","","30.00","Select","Select",""],["","00378064110","PREDNISONE ","10MG","9.00","Select","Select",""],["","63304069301","CLINDAMYCIN ","300MG","21.00","Select","Select",""],["","00093416178","AMOXICILLIN ","400\/5ML","150.00","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","10.00","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":""}]}]}