{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"IRENE OGILVIE","gend":1,"add":"242 LIBERTY AVENUE","city":"WINCHESTER","state":"VA","zip":"22601-5315","dob":"1971-11-12","age":"","mstatus":"","insh":"11012068","cliId":"","pno":5403034143,"cno":"","email":"","ename":"","eno":"","pphy":"DELANOY, ANNE E","ppno":3042634999,"pcpadd":"99 Tavern Rd PO Box 1146","pcpcity":"Martinsburg","pcpstate":"WV","pcpzip":254012890,"pcpcounty":"","pcpid":"","pcpname":"WINCHESTER FAMILY HEALTH CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"242 LIBERTY AVENUE","madd2":"","madd3":"","mcity":"WINCHESTER","mstate":"VA","mzip":"22601-5315","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":[["","00003089421","ELIQUIS ","5MG","60.00","Select","Select",""],["","43547028210","ESCITALOPRAM ","20MG","90.00","Select","Select",""],["","65702071110","ACCU-CHEK ","GUIDE","100.00","Select","Select",""],["","13668008190","MONTELUKAST ","10MG","30.00","Select","Select",""],["","65702028810","FASTCLIX ","LANCETS","100.00","Select","Select",""],["","51991070405","ALPRAZOLAM ","0.25MG","10.00","Select","Select",""],["","65702073110","ACCU-CHECK ","GUIDE ME","1.00","Select","Select",""],["","00093220405","METOCLOPRAM ","5MG","20.00","Select","Select",""],["","68180098103","LISINOPRIL ","20MG","90.00","Select","Select",""],["","00378001801","METOPROL ","25MG","60.00","Select","Select",""],["","59762444002","METHYLPRED ","4MG","21.00","Select","Select",""],["","00054001925","PREDNISONE ","50MG","5.00","Select","Select",""],["","68382014014","TOPIRAMATE ","100MG","180.00","Select","Select",""],["","00143980305","DOXYCYCL ","100MG","20.00","Select","Select",""],["","70010006310","METFORMIN ","500MG","60.00","Select","Select",""],["","57664037718","TRAMADOL ","50MG","30.00","Select","Select",""],["","00487950125","ALBUTEROL ","0.08%","150.00","Select","Select",""],["","65162027250","SMZ\/TMP ","800-160","14.00","Select","Select",""],["","67877021905","CEPHALEXIN ","500MG","10.00","Select","Select",""],["","69097084615","CYCLOBENZAPR ","10MG","20.00","Select","Select",""],["","68462015713","ONDANSETRON ","4MG ODT","12.00","Select","Select",""],["","47781030301","NITROFURANTN ","100MG","14.00","Select","Select",""],["","60505258009","ATORVASTATIN ","40MG","90.00","Select","Select",""],["","55111028130","LEVOFLOXACIN ","750MG","4.00","Select","Select",""],["","61442010301","DICLOFENAC ","75MG DR","90.00","Select","Select",""],["","00093031401","KETOROLAC ","10MG","15.00","Select","Select",""],["","65162052111","PROMETHAZINE ","25MG","30.00","Select","Select",""],["","27808003501","HYDROCO\/APAP ","5-325MG","6.00","Select","Select",""],["","65162004710","OXYCODONE ","5MG","42.00","Select","Select",""],["","65862052305","GABAPENTIN ","600MG","60.00","Select","Select",""],["","00310737020","BUDES\/FORMOT ","160-4.5","10.20","Select","Select",""],["","29300022705","METRONIDAZOL ","500MG","21.00","Select","Select",""],["","47781019601","OXYCOD\/APAP ","5-325MG","18.00","Select","Select",""],["","57237001899","DULOXETINE ","30MG","30.00","Select","Select",""],["","00121086750","VANCOMYCIN ","125MG","56.00","Select","Select",""],["","69547035302","NARCAN ","","2.00","Select","Select",""],["","00527169505","BUT\/APAP\/CAF ","","20.00","Select","Select",""],["","50111078810","AZITHROMYCIN ","500MG","5.00","Select","Select",""],["","00093227534","AMOX\/K ","875-125","14.00","Select","Select",""],["","00143992801","CIPROFLOXACN ","500MG","14.00","Select","Select",""],["","65862017760","CEFDINIR ","300MG","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":["",""]}},{"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":""}]}]}