{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BARBARA A PEARSON","gend":1,"add":"103 RIDGE STREET","city":"BROOKNEAL","state":"VA","zip":"24528-9998","dob":"1940-07-27","age":"","mstatus":"","insh":"11013385","cliId":"","pno":4343767676,"cno":"","email":"","ename":"","eno":"","pphy":"WALDRON, VINCENT JOHN","ppno":4343762325,"pcpadd":"104 Carolina Ave","pcpcity":"Brookneal","pcpstate":"VA","pcpzip":245282643,"pcpcounty":"","pcpid":"","pcpname":"CENTRA MEDICAL GROUP","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"103 RIDGE STREET","madd2":"","madd3":"","mcity":"BROOKNEAL","mstate":"VA","mzip":"24528-9998","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":[["","60758061525","GATIFLOXACIN ","0.50%","2.50","Select","Select",""],["","60758011905","PREDNISOLONE ","1% OP","5.00","Select","Select",""],["","00173085910","BREO ","100-25","60.00","Select","Select",""],["","00093317431","ALBUTEROL ","E","8.50","Select","Select",""],["","65862035790","CLOPIDOGREL ","75MG","90.00","Select","Select",""],["","70377003012","ATORVASTATIN ","80MG","90.00","Select","Select",""],["","00378797052","IPRATROPIUM ","0.02%INH","312.50","Select","Select",""],["","57664050658","METOPROL ","25MG","30.00","Select","Select",""],["","24208060203","PROLENSA ","0.07%","3.00","Select","Select",""],["","62332002531","THEOPHYLLINE ","300MG ER","90.00","Select","Select",""],["","00078065920","ENTRESTO ","24-26MG","60.00","Select","Select",""],["","62175061743","PANTOPRAZOLE ","40MG","90.00","Select","Select",""],["","49483060350","IBUPROFEN ","600MG","360.00","Select","Select",""],["","76385011050","CARVEDILOL ","3.125MG","180.00","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","48.00","Select","Select",""],["","00023916360","RESTASIS ","0.05%","180.00","Select","Select",""],["","65162083366","DICLOFENAC ","1%","100.00","Select","Select",""],["","00378064205","PREDNISONE ","20MG","10.00","Select","Select",""],["","49281012065","FLUZONE ","PF 20-21","0.70","Select","Select",""],["","55111015810","OMEPRAZOLE ","20MG","90.00","Select","Select",""],["","70461012103","FLUAD ","2021-22","0.50","Select","Select",""],["","68180016006","AZITHROMYCIN ","250MG","6.00","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":""}]}]}