{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BARBARA A BERRY","gend":1,"add":"6145 ORANGE RD","city":"ORANGE","state":"VA","zip":"22960-9998","dob":"1952-07-04","age":"","mstatus":"","insh":"11012702","cliId":"","pno":5406725145,"cno":"","email":"","ename":"","eno":"","pphy":"BADARACCO, MARIA C","ppno":5406613004,"pcpadd":"661 University Ln Ste E","pcpcity":"Orange","pcpstate":"VA","pcpzip":229602243,"pcpcounty":"","pcpid":"","pcpname":"UVA ORANGE DIALYSIS","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"6145 ORANGE RD","madd2":"","madd3":"","mcity":"ORANGE","mstate":"VA","mzip":"22960-9998","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":[["","65162083366","DICLOFENAC ","1%","100.00","Select","Select",""],["","65702043810","ACCU-CHEK ","AVIVA PL","100.00","Select","Select",""],["","59762080002","TOLTERODINE ","2MG","180.00","Select","Select",""],["","67877022205","GABAPENTIN ","100MG","90.00","Select","Select",""],["","00006027754","JANUVIA ","100MG","90.00","Select","Select",""],["","61314022710","TIMOLOL ","0.5% OP","10.00","Select","Select",""],["","61314054701","LATANOPROST ","0.01%","7.50","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","20.00","Select","Select",""],["","61314014305","BRIMONIDINE ","0.2% OP","10.00","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","48.00","Select","Select",""],["","65862041901","SMZ-TMP ","400-80MG","14.00","Select","Select",""],["","62756014202","METFORMIN ","500MG ER","360.00","Select","Select",""],["","00597015290","JARDIANCE ","10MG","90.00","Select","Select",""],["","68382013510","LOSARTAN ","25MG","90.00","Select","Select",""],["","60505257908","ATORVASTATIN ","20MG","90.00","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","1.00","Select","Select",""],["","65862007601","CIPROFLOXACN ","250MG","6.00","Select","Select",""],["","55111046605","METOPROL ","25MG ER","90.00","Select","Select",""],["","69097015812","MELOXICAM ","7.5MG","30.00","Select","Select",""],["","69097084507","CYCLOBENZAPR ","5MG","12.00","Select","Select",""],["","70710113908","FLUCONAZOLE ","150MG","1.00","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":""}]}]}