{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PHYLLIS B MCCORMICK","gend":1,"add":"8300 RICHMOND HWY.","city":"GLADSTONE","state":"VA","zip":"24553-3126","dob":"1954-07-27","age":"","mstatus":"","insh":"11007557","cliId":"","pno":4344735140,"cno":"","email":"","ename":"","eno":"","pphy":"CASEY, CATHERINE F","ppno":4349245348,"pcpadd":"345 FOUR LEAF LANE SUITE 103","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":229080001,"pcpcounty":"","pcpid":"","pcpname":"UVA FAMILY MEDICINE INTERNAL MED AND SPECIALTY","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"8300 RICHMOND HWY.","madd2":"","madd3":"","mcity":"GLADSTONE","mstate":"VA","mzip":"24553-3126","pcpfaxno":"(434) 244-9477","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":[["","68645057390","GLIMEPIRIDE ","4MG","60.00","Select","Select",""],["","00002143480","TRULICITY ","1.5\/0.5","2.00","Select","Select",""],["","31722094201","HYDROCO\/APAP ","7.5-325","120.00","Select","Select",""],["","43547028111","ESCITALOPRAM ","10MG","90.00","Select","Select",""],["","50228017705","GABAPENTIN ","600MG","360.00","Select","Select",""],["","55111015930","OMEPRAZOLE ","40MG","90.00","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","473.00","Select","Select",""],["","00093317431","ALBUTEROL ","E","8.50","Select","Select",""],["","00169185550","NOVOFINE ","32GX4MM","100.00","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16.00","Select","Select",""],["","45802006435","TRIAMCINOLON ","0.10%","15.00","Select","Select",""],["","65162083366","DICLOFENAC ","1%","100.00","Select","Select",""],["","68645056854","ATORVASTATIN ","40MG","90.00","Select","Select",""],["","16714008212","HYDROXYZ ","25MG","180.00","Select","Select",""],["","68382009505","CARVEDILOL ","25MG","180.00","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","LITE","300.00","Select","Select",""],["","68382080601","TRAZODONE ","100MG","90.00","Select","Select",""],["","00093005405","BUSPIRONE ","10MG","270.00","Select","Select",""],["","43547040211","FUROSEMIDE ","40MG","90.00","Select","Select",""],["","00456120230","LINZESS ","290MCG","90.00","Select","Select",""],["","00006011231","JANUVIA ","50MG","90.00","Select","Select",""],["","68645055254","LISINOPRIL ","10MG","90.00","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21.00","Select","Select",""],["","00169266015","TRESIBA ","100UNIT","15.00","Select","Select",""],["","64380072306","CALCITRIOL ","0.25MCG","36.00","Select","Select",""],["","59310057922","PROAIR ","","25.50","Select","Select",""],["","00143928501","AMOXICILLIN ","875MG","20.00","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":""}]}]}