{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BERNETTA LEWIS","gend":1,"add":"1009 HERITAGE PARK","city":"ENON","state":"VA","zip":"22401-9998","dob":"1963-12-03","age":"","mstatus":"","insh":"11009855","cliId":"","pno":5403615578,"cno":"","email":"","ename":"","eno":"","pphy":"BAIG, MIRZA M","ppno":5403687316,"pcpadd":"300 Park Hill Dr","pcpcity":"Fredericksburg","pcpstate":"VA","pcpzip":224013387,"pcpcounty":"","pcpid":"","pcpname":"METROPOLITAN HEALTH CARE PROVIDERS INC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"APT 101","add3":"","madd1":"1009 HERITAGE PARK","madd2":"APT 101","madd3":"","mcity":"ENON","mstate":"VA","mzip":"22401-9998","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":[["","65862014305","CARVEDILOL ","6.25MG","180.00","Select","Select",""],["","31722070290","LOSARTAN ","100MG","90.00","Select","Select",""],["","00169643810","LEVEMIR ","FLEXTOUC","15.00","Select","Select",""],["","00597015390","JARDIANCE ","25MG","90.00","Select","Select",""],["","08290320109","BD  PEN NEEDL","31GX8MM","100.00","Select","Select",""],["","00555030202","HYDROXYZ ","50MG","30.00","Select","Select",""],["","68180072103","AMLODIPINE ","10MG","90.00","Select","Select",""],["","60505024701","MIRTAZAPINE ","15MG","30.00","Select","Select",""],["","65162044110","MECLIZINE ","12.5MG","25.00","Select","Select",""],["","53885027150","ONETOUCH ","VERIO","250.00","Select","Select",""],["","43598075205","BUPROPION ","150MG SR","30.00","Select","Select",""],["","68180044701","QUETIAPINE ","100MG","30.00","Select","Select",""],["","75834021730","VENLAFAXINE ","75MG ER","30.00","Select","Select",""],["","55111064530","OMEPRAZOLE ","40MG","30.00","Select","Select",""],["","70069042101","LATANOPROST ","0.01%","2.50","Select","Select",""],["","00310737020","BUDES\/FORMOT ","160-4.5","10.20","Select","Select",""],["","27808008602","HYD ","10-8\/5ML","200.00","Select","Select",""],["","33332032001","AFLURIA ","2020-21","0.50","Select","Select",""],["","67877041301","METFORMIN ","500MG ER","360.00","Select","Select",""],["","70377003012","ATORVASTATIN ","80MG","90.00","Select","Select",""],["","55111018015","TIZANIDINE ","4MG","30.00","Select","Select",""],["","53746051101","SPIRONOLACT ","25MG","90.00","Select","Select",""],["","59746017310","PREDNISONE ","10MG","90.00","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16.00","Select","Select",""],["","00054004544","IPRATROPIUM ","0.03%","30.00","Select","Select",""],["","00597002402","COMBIVENT ","20-100","4.00","Select","Select",""],["","70010077001","METHOCARBAM ","750MG","30.00","Select","Select",""],["","00406048410","APAP\/CODEINE ","300-30MG","14.00","Select","Select",""],["","00024576105","SOLIQUA ","100\/33","15.00","Select","Select",""],["","00173068220","VENTOLIN ","","18.00","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","SENSOR","2.00","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0.50","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","READER","1.00","Select","Select",""],["","16571020150","DICLOFENAC ","75MG DR","60.00","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":["",""]}},{"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":""}]}]}