{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CYNTHIA BARROS","gend":1,"add":"518 OAKHILL ROAD","city":"STAUNTON","state":"VA","zip":"24401-9998","dob":"1958-07-02","age":"","mstatus":"","insh":"11013495","cliId":"","pno":9513243288,"cno":"","email":"","ename":"","eno":"","pphy":"FARLEY, BENJAMIN GATES","ppno":5408866259,"pcpadd":"42 Lambert StSte 511","pcpcity":"Staunton","pcpstate":"VA","pcpzip":244012437,"pcpcounty":"","pcpid":"","pcpname":"AUGUSTA HEALTH URGENT CARE STAUNTON","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"518 OAKHILL ROAD","madd2":"","madd3":"","mcity":"STAUNTON","mstate":"VA","mzip":"24401-9998","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":[["","68180031906","BUPROPN ","150MG XL","30.00","Select","Select",""],["","76204060030","IPRATROPIUM\/ ","ALBUTER","90.00","Select","Select",""],["","00069046856","CHANTIX ","0.5MG","56.00","Select","Select",""],["","69238183407","LEVOTHYROXIN ","100MCG","90.00","Select","Select",""],["","43547033610","BENAZEPRIL ","10MG","45.00","Select","Select",""],["","43068011202","FANAPT ","12MG","60.00","Select","Select",""],["","00046110281","PREMARIN ","0.625MG","90.00","Select","Select",""],["","27808003702","HYDROCO\/APAP ","10-325MG","78.00","Select","Select",""],["","68462015305","TOPIRAMATE ","50MG","270.00","Select","Select",""],["","00527409437","BUT\/APAP\/CAF ","","30.00","Select","Select",""],["","16571020150","DICLOFENAC ","75MG DR","90.00","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","48.00","Select","Select",""],["","62332025050","DOXYCYC ","100MG","20.00","Select","Select",""],["","00597010061","SPIRIVA ","2.5MCG","4.00","Select","Select",""],["","50111043401","TRAZODONE ","100MG","30.00","Select","Select",""],["","67877024801","QUETIAPINE ","400MG","30.00","Select","Select",""],["","65862057490","MONTELUKAST ","10MG","90.00","Select","Select",""],["","50458054360","INVOKAMET ","150-1000","180.00","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","54.00","Select","Select",""],["","59746011506","PROCHLORPER ","10MG","30.00","Select","Select",""],["","00378932132","WIXELA ","250\/50","180.00","Select","Select",""],["","68180046403","SIMVASTATIN ","40MG","90.00","Select","Select",""],["","57237005920","CEFUROXIME ","500MG","20.00","Select","Select",""],["","42806008660","BUSPIRONE ","30MG","60.00","Select","Select",""],["","00002143480","TRULICITY ","1.5\/0.5","6.00","Select","Select",""],["","52817032010","BACLOFEN ","10MG","90.00","Select","Select",""],["","68462012605","GABAPENTIN ","600MG","540.00","Select","Select",""],["","55111029209","SUMATRIPTAN ","50MG","9.00","Select","Select",""],["","57237000511","FLUCONAZOLE ","150MG","2.00","Select","Select",""],["","00173069600","ADVAIR ","250\/50","180.00","Select","Select",""],["","55111015330","ONDANSETRON ","4MG","10.00","Select","Select",""],["","65862053820","LEVOFLOXACIN ","750MG","7.00","Select","Select",""],["","00591544305","PREDNISONE ","20MG","18.00","Select","Select",""],["","00143993905","AMOXICILLIN ","500MG","30.00","Select","Select",""],["","68180029407","DULOXETINE ","20MG","30.00","Select","Select",""],["","31722053401","METHOCARBAM ","750MG","270.00","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":""}]}]}