{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRENDA L BROOKS","gend":1,"add":"711 CONCORD AVE","city":"CHARLOTTESVILLE","state":"VA","zip":"22903-9998","dob":"1949-03-15","age":"","mstatus":"","insh":"11009149","cliId":"","pno":4348069808,"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 MEDICINE AND SPECIALT","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"711 CONCORD AVE","madd2":"","madd3":"","mcity":"CHARLOTTESVILLE","mstate":"VA","mzip":"22903-9998","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":[["","00781540192","ROSUVASTATIN ","10MG","90.00","Select","Select",""],["","76204020025","ALBUTEROL ","0.08%","150.00","Select","Select",""],["","51991074810","DULOXETINE ","60MG","90.00","Select","Select",""],["","59310057922","PROAIR ","","8.50","Select","Select",""],["","00603499821","OXYCOD\/APAP ","5-325MG","180.00","Select","Select",""],["","00173088214","BREO ","200-25","28.00","Select","Select",""],["","57664050658","METOPROL ","25MG","90.00","Select","Select",""],["","00054001829","PREDNISONE ","20MG","8.00","Select","Select",""],["","68382050010","OMEPRAZOLE ","40MG","90.00","Select","Select",""],["","16729011915","MONTELUKAST ","10MG","90.00","Select","Select",""],["","00597007547","SPIRIVA ","HANDIHLR","90.00","Select","Select",""],["","00228255011","DICLOFENAC ","50MG DR","180.00","Select","Select",""],["","43547039910","CYCLOBENZAPR ","5MG","30.00","Select","Select",""],["","00781261301","AMOXICILLIN ","500MG","14.00","Select","Select",""],["","53489015610","ALLOPURINOL ","100MG","90.00","Select","Select",""],["","00574027501","POT  CHLORIDE","10MEQ ER","60.00","Select","Select",""],["","65862050301","AMOX\/K ","875-125","28.00","Select","Select",""],["","50111078751","AZITHROMYCIN ","250MG","6.00","Select","Select",""],["","00378668910","PANTOPRAZOLE ","40MG","120.00","Select","Select",""],["","00186037020","SYMBICORT ","160-4.5","10.20","Select","Select",""],["","00168035730","LIDO\/PRILOCN ","2.5-2.5%","30.00","Select","Select",""],["","00527128201","DICYCLOMINE ","20MG","60.00","Select","Select",""],["","00603459315","METHYLPRED ","4MG","21.00","Select","Select",""],["","00378210005","LOPERAMIDE ","2MG","30.00","Select","Select",""],["","00245531615","KLOR-CON ","10MEQ ER","60.00","Select","Select",""],["","00054829725","FUROSEMIDE ","20MG","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":["",""]}},{"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":""}]}]}