{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LARRY COOKE","gend":0,"add":"100 MARTHA LEE DR APT 196","city":"HAMPTON","state":"VA","zip":"23666-9998","dob":"1952-10-05","age":"","mstatus":"","insh":"11004858","cliId":"","pno":7575326267,"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":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"100 MARTHA LEE DR APT 196","madd2":"","madd3":"","mcity":"HAMPTON","mstate":"VA","mzip":"23666-9998","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":[["","00173088710","TRELEGY ","ELLIPTA","60.00","Select","Select",""],["","13668010401","ISOSORB ","30MG ER","30.00","Select","Select",""],["","55111019690","CLOPIDOGREL ","75MG","30.00","Select","Select",""],["","68382077306","EZETIMIBE ","10MG","30.00","Select","Select",""],["","65162063709","PANTOPRAZOLE ","40MG","30.00","Select","Select",""],["","65862057490","MONTELUKAST ","10MG","30.00","Select","Select",""],["","59746021601","SPIRONOLACT ","25MG","30.00","Select","Select",""],["","52817027110","BISOPROL ","10MG","30.00","Select","Select",""],["","00054429931","FUROSEMIDE ","40MG","60.00","Select","Select",""],["","67877019805","AMLODIPINE ","5MG","30.00","Select","Select",""],["","00173088210","BREO ","200-25","180.00","Select","Select",""],["","00173087310","INCRUSE ","62.5MCG","30.00","Select","Select",""],["","50228018005","GABAPENTIN ","300MG","90.00","Select","Select",""],["","49884072703","DOXYCYC ","100MG","20.00","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16.00","Select","Select",""],["","65162083366","DICLOFENAC ","1%","500.00","Select","Select",""],["","69097094705","ATORVASTATIN ","80MG","30.00","Select","Select",""],["","59746017306","PREDNISONE ","10MG","42.00","Select","Select",""],["","61314054701","LATANOPROST ","0.01%","2.50","Select","Select",""],["","70461001903","FLUAD ","2019-20","0.50","Select","Select",""],["","52817032010","BACLOFEN ","10MG","60.00","Select","Select",""],["","68462063945","NITROGLYCERN ","0.4MG","50.00","Select","Select",""],["","16714047801","AMOX\/K ","875-125","20.00","Select","Select",""],["","00093310953","AMOXICILLIN ","500MG","30.00","Select","Select",""],["","00487950125","ALBUTEROL ","0.08%","75.00","Select","Select",""],["","00310461612","BREZTRI ","SPHERE","32.10","Select","Select",""],["","00006483703","PNEUMOVAX ","25\/0.5","0.50","Select","Select",""],["","70010075401","METHOCARBAM ","500MG","40.00","Select","Select",""],["","00186037020","SYMBICORT ","160-4.5","10.20","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":["",""]}},{"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":""}]}]}