{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PAUL M HORNBERGER","gend":0,"add":"314 MOORE STREET","city":"BRISTOL","state":"VA","zip":"24201-4368","dob":"1952-11-03","age":"","mstatus":"","insh":"11004432","cliId":"","pno":7575936892,"cno":"","email":"","ename":"","eno":"","pphy":"LORENZO, DAVID","ppno":7575910643,"pcpadd":"4714 Marshall Ave","pcpcity":"Newport News","pcpstate":"VA","pcpzip":236072247,"pcpcounty":"","pcpid":"","pcpname":"PENINSULA INSTITUTE FOR COMMUNITY HEALTH INC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"APT 7","add3":"","madd1":"314 MOORE STREET","madd2":"APT 7","madd3":"","mcity":"BRISTOL","mstate":"VA","mzip":"24201-4368","pcpfaxno":"(757) 952-1345","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":[["","60758011905","PREDNISOLONE ","1% OP","5.00","Select","Select",""],["","00406052301","OXYCOD\/APAP ","10-325MG","120.00","Select","Select",""],["","00093317431","ALBUTEROL ","E HFA INH","25.50","Select","Select",""],["","64380075806","ACARBOSE ","25MG","90.00","Select","Select",""],["","47335022090","KETOROLAC ","0.50%","5.00","Select","Select",""],["","31722088490","ROSUVASTATIN ","20MG","90.00","Select","Select",""],["","16729021816","CLOPIDOGREL ","75MG","90.00","Select","Select",""],["","00003089421","ELIQUIS ","5MG","180.00","Select","Select",""],["","16729000617","SIMVASTATIN ","40MG","90.00","Select","Select",""],["","57237010099","METOPROL ","25MG","180.00","Select","Select",""],["","61314062810","POLYMYXIN ","TRIMETHP","10.00","Select","Select",""],["","68180021509","LOSARTAN\/HCT ","50-12.5","30.00","Select","Select",""],["","16729018201","HYDROCHLOROT ","12.5MG","90.00","Select","Select",""],["","65862020299","LOSARTAN ","50MG","90.00","Select","Select",""],["","43598043601","NITROGLYCERN ","0.4MG","100.00","Select","Select",""],["","64764024060","AMITIZA ","24MCG","30.00","Select","Select",""],["","69547035302","NARCAN ","","2.00","Select","Select",""],["","00378911293","NITROGLYCER ","0.4MG\/HR","30.00","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":""}]}]}