{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DIANE M NESTER","gend":1,"add":"2027 W Grace St","city":"Richmond","state":"VA","zip":"23220-2003","dob":"1976-07-10","age":"","mstatus":"","insh":"11007573","cliId":"","pno":8044185438,"cno":8043589300,"email":"","ename":"","eno":"","pphy":"GLADFELTER, BAMBI L","ppno":8042391640,"pcpadd":"12018 W Broad St Ste 100","pcpcity":"Henrico","pcpstate":"VA","pcpzip":232337796,"pcpcounty":"","pcpid":"","pcpname":"PRIMARY CARE OF WEST END LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"2027 W Grace St","madd2":"","madd3":"","mcity":"Richmond","mstate":"VA","mzip":"23220-2003","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":[["","16729021616","SERTRALINE ","50MG","7.00","Select","Select",""],["","50458056101","INVEGA ","78\/0.5ML","0.50","Select","Select",""],["","62756014202","METFORMIN ","500MG ER","31.00","Select","Select",""],["","53746027201","SMZ\/TMP ","800-160","14.00","Select","Select",""],["","00591369330","PALIPERIDONE ","ER 3MG","30.00","Select","Select",""],["","00378456077","POT  CHLORIDE","8MEQ ER","31.00","Select","Select",""],["","62559046190","FENOFIBRATE ","150MG","30.00","Select","Select",""],["","00378210005","LOPERAMIDE ","2MG","14.00","Select","Select",""],["","60505257808","ATORVASTATIN ","10MG","15.00","Select","Select",""],["","68382079105","ACYCLOVIR ","400MG","14.00","Select","Select",""],["","00378668910","PANTOPRAZOLE ","40MG","31.00","Select","Select",""],["","24979015514","CEPHALEXIN ","250\/5ML","280.00","Select","Select",""],["","00093227534","AMOX\/K ","875-125","20.00","Select","Select",""],["","55111068305","IBU ","600MG","16.00","Select","Select",""],["","16729011917","MONTELUKAST ","10MG","11.00","Select","Select",""],["","00378342201","NITROFURANTN ","100MG","14.00","Select","Select",""],["","67877032005","IBUPROFEN ","600MG","40.00","Select","Select",""],["","52268001201","SUPREP ","PREP KIT","354.00","Select","Select",""],["","24208039830","IPRATROPIUM ","0.03%","30.00","Select","Select",""],["","08327006829","SAFETY ","LANCETS","100.00","Select","Select",""],["","56151146001","TRUE ","GLUCOSE","100.00","Select","Select",""],["","16729016917","ESCITALOPRAM ","10MG","30.00","Select","Select",""],["","08290326895","BD ","SNGL USE","100.00","Select","Select",""],["","42806016105","HYDROXYZ ","50MG","30.00","Select","Select",""],["","10572010101","PEG-3350 ","ELECTROL","4,000.00","Select","Select",""],["","58160088752","FLUARIX ","2021-22","0.50","Select","Select",""],["","53489012002","DOXYCYCL ","100MG","14.00","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}