{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANN T BATTISTE","gend":1,"add":"101 PINE RIDGE DR","city":"LOUISA","state":"VA","zip":"23093-9998","dob":"1938-01-24","age":"","mstatus":"","insh":"11004726","cliId":"","pno":5407480705,"cno":"","email":"","ename":"","eno":"","pphy":"YOUNG, EMILY ELIZABETH","ppno":4342439466,"pcpadd":"435 Merchant Walk Sq Ste 400","pcpcity":"Charlottesville","pcpstate":"VA","pcpzip":229026516,"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":"101 PINE RIDGE DR","madd2":"","madd3":"","mcity":"LOUISA","mstate":"VA","mzip":"23093-9998","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":[["","00093300993","LANSOPRAZOLE ","30MG","90.00","Select","Select",""],["","68382009505","CARVEDILOL ","25MG","60.00","Select","Select",""],["","59762040101","SUCRALFATE ","1GM","90.00","Select","Select",""],["","00173069600","ADVAIR ","250\/50","180.00","Select","Select",""],["","60505083305","AZELASTINE ","0.10%","30.00","Select","Select",""],["","16729013516","ALLOPURINOL ","300MG","90.00","Select","Select",""],["","59310057922","PROAIR ","","8.50","Select","Select",""],["","47781050901","TETRACYCLINE ","500MG","52.00","Select","Select",""],["","60758018805","GENTAMICIN ","0.3% OP","5.00","Select","Select",""],["","00378108601","COLCHICINE ","0.6MG","30.00","Select","Select",""],["","00093317431","ALBUTEROL ","E","25.50","Select","Select",""],["","69097052444","DICLOFENAC ","1%","100.00","Select","Select",""],["","50111033302","METRONIDAZOL ","250MG","52.00","Select","Select",""],["","00054429931","FUROSEMIDE ","40MG","90.00","Select","Select",""],["","62037083201","METOPROL ","100MG ER","90.00","Select","Select",""],["","00186091706","PULMICORT ","90MCG","1.00","Select","Select",""],["","50111032703","HYDRALAZINE ","25MG","270.00","Select","Select",""],["","70954005920","PREDNISONE ","10MG","60.00","Select","Select",""],["","65862020299","LOSARTAN ","50MG","90.00","Select","Select",""],["","51862044630","TAMOXIFEN ","20MG","90.00","Select","Select",""],["","00186037020","SYMBICORT ","160-4.5","10.20","Select","Select",""],["","68180098103","LISINOPRIL ","20MG","45.00","Select","Select",""],["","68180072103","AMLODIPINE ","10MG","90.00","Select","Select",""],["","48102005101","DEXAMETHASON ","4MG","40.00","Select","Select",""],["","61314063705","PREDNISOLONE ","1% OP","10.00","Select","Select",""],["","00781808926","AZITHROMYCIN ","250MG","6.00","Select","Select",""],["","71369002010","DOPTELET ","20MG","40.00","Select","Select",""],["","57237007710","ONDANSETRON ","4MG ODT","20.00","Select","Select",""],["","00713072615","MOMETASONE ","0.10%","45.00","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","20.00","Select","Select",""],["","00574402435","ERYTHROMYCIN ","5MG\/GM","3.50","Select","Select",""],["","57237002801","AMOXICILLIN ","500MG","14.00","Select","Select",""],["","00378210001","LOPERAMIDE ","2MG","30.00","Select","Select",""],["","65862017760","CEFDINIR ","300MG","20.00","Select","Select",""],["","71332000201","TAVALISSE ","150MG","60.00","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","20.00","Select","Select",""],["","67877021560","CEFUROXIME ","250MG","14.00","Select","Select",""],["","00597007541","SPIRIVA ","HANDIHLR","30.00","Select","Select",""],["","29300012810","HYDROCHLOROT ","25MG","90.00","Select","Select",""],["","00574402235","BACITRACIN ","OP","3.50","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","30.00","Select","Select",""],["","69238183207","LEVOTHYROXIN ","75MCG","90.00","Select","Select",""],["","31722072690","MONTELUKAST ","10MG","30.00","Select","Select",""],["","00781185220","AMOX\/K ","875-125","20.00","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","16.00","Select","Select",""],["","00406055201","OXYCODONE ","5MG","5.00","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":""}]}]}