{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BERNICE P MORRISON","gend":1,"add":"671 12 ST","city":"NEWPORT NEWS","state":"VA","zip":"23607-9998","dob":"1947-05-08","age":"","mstatus":"","insh":"11010790","cliId":"","pno":7572447141,"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":"671 12 ST","madd2":"","madd3":"","mcity":"NEWPORT NEWS","mstate":"VA","mzip":"23607-9998","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":[["","00378718505","METFORMIN ","500MG","30.00","Select","Select",""],["","00781569031","EZETIMIBE ","10MG","30.00","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","60.00","Select","Select",""],["","65862020399","LOSARTAN ","100MG","75.00","Select","Select",""],["","60505014202","GLIPIZIDE ","10MG","90.00","Select","Select",""],["","00093317431","ALBUTEROL ","E","8.50","Select","Select",""],["","45963067711","METOPROL ","100MG ER","90.00","Select","Select",""],["","68180072103","AMLODIPINE ","10MG","90.00","Select","Select",""],["","16729041501","DOXAZOSIN ","8MG","90.00","Select","Select",""],["","00054429731","FUROSEMIDE ","20MG","90.00","Select","Select",""],["","52817033200","CYCLOBENZAPR ","10MG","90.00","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","48.00","Select","Select",""],["","00310737220","BUDES\/FORMOT ","80-4.5","10.20","Select","Select",""],["","59310057922","PROAIR ","","8.50","Select","Select",""],["","00472037915","CLOTRIM\/BETA ","DIPROP","60.00","Select","Select",""],["","64980034214","ALENDRONATE ","70MG","12.00","Select","Select",""],["","65862001705","AMOXICILLIN ","500MG","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":["",""],"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":""}]}]}