{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GINA   K BAXTER","gend":1,"add":"1501 VIRGINIA AVE APT 312","city":"HARRISONBURG","state":"VA","zip":"22802-9998","dob":"1951-09-07","age":"","mstatus":"","insh":"900035784*01","cliId":"7YG4TJ4HF68","pno":"571\/247-1179","cno":"571\/247-1179","email":"","ename":"","eno":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I69.354","I89.0","R13.10","I11.0","I50.32","R15.9","R32.","I48.91","G89.29","F41.9","K21.9","E11.65","E66.01","Z68.43","G47.33","E03.9","J45.909","E11.9","N39.0","E78.5","E87.6","J96.10","R07.9","E11.43","K31.84","I50.33","E11.40","Z79.01","R39.81","B19.9","M51.26","E08.21","I80.01","E07.9","I25.10","M85.80","E66.9","Z79.82","Z79.899","Z79.4","Z79.51","Z79.890","Z86.73","I50.30","J96.11","I48.21","R53.81","Z23.","J44.9","R06.02","R10.84","R47.1","N30.00","R20.0","I63.9","U07.1","N39.46","Z71.3","Q82.0","J45.40","G62.9","M25.512","I48.2","J01.90","R09.02","B96.89","I50.9","Z99.81","R53.1","R79.1","R06.00","E11.42","I48.20","M79.604","M79.605","R07.81","M62.81","K59.00","J30.2","H69.83","B02.9","E66.2","R29.810","R48.2","R30.0","R11.10","R10.13","R12.","K44.9","K20.8","J96.01","R74.8","R91.8","J02.9","J96.21","J32.9","R06.9","R60.9","R21.","K59.09","J30.1","E11.21","R26.9","M47.814","M54.6","R10.9","I08.1","I67.9","I69.921","J44.1","F41.1","G47.34","Z20.828","Z09.","N28.89","G47.30","I48.0","J45.30","E55.9","L60.2","R10.12","R04.0","J45.41","R25.2","R52.","B37.0","Z74.01","N63.0","Z91.041","Z88.5","Z88.0","Z91.013","Z88.8","Z91.048","I51.7","I27.20","L85.3","B96.29","Z16.12","A49.02","I65.23","I69.391","R63.5","Q24.8","I50.42","Z91.018","Z82.49","J18.1","Z02.9","I67.89","I63.40","I48.92","R60.0","B35.1","M19.022","M25.522","M19.012","Z99.3","R06.09","I50.22","Z74.09","H66.90","R47.02","R13.14","I27.29","K22.8","M15.9","N30.20","Z86.718","N18.30","E11.22","R07.89","R42.","J81.1","R04.2","R68.89","K59.01","R10.10","R06.2","N28.1","M19.071","M25.571","I82.441","I49.3","Z68.42","N39.498","E11.8","M13.0","R94.2","M19.90","E66.09","J40.","M79.89","R22.41","J18.9","B37.3","I82.432","Z91.09","I50.20","J98.01","Z66.","I82.502","I70.0","Z79.2","Z87.440","J98.4","W19.XXXA","S46.912A","R93.89","Z71.89","R09.89","J80.","I50.31"],"date":["2020-08-23","2021-11-16","2020-10-07","2020-07-29","2021-11-11","2020-07-15","2020-07-15","2021-10-08","2020-07-15","2020-07-15","2021-10-08","2021-10-08","2021-10-28","2021-10-28","2021-10-28","2021-10-08","2021-10-08","2021-10-11","2021-05-05","2021-10-08","2020-09-02","2020-07-29","2021-10-08","2021-10-08","2021-10-08","2021-11-24","2021-11-16","2021-11-16","2021-09-13","2020-10-12","2020-10-12","2020-10-12","2020-11-25","2020-10-19","2021-10-08","2021-11-11","2021-09-14","2020-10-19","2021-08-17","2021-09-14","2020-10-19","2020-10-19","2021-10-08","2021-11-16","2021-11-16","2021-11-16","2021-09-30","2020-10-21","2021-10-28","2021-09-13","2020-02-23","2020-05-15","2021-09-27","2020-05-06","2021-05-19","2020-06-26","2021-09-27","2021-06-16","2021-09-30","2021-11-16","2021-02-08","2021-11-16","2019-09-16","2021-11-16","2021-10-28","2020-01-24","2020-11-13","2021-09-13","2021-09-30","2019-10-30","2021-10-08","2021-10-19","2020-02-14","2021-08-20","2021-08-20","2020-01-13","2020-06-09","2020-12-12","2021-08-03","2020-03-19","2020-03-19","2021-09-13","2020-05-04","2020-05-04","2020-07-17","2020-08-25","2020-08-27","2020-08-27","2020-08-27","2020-08-27","2021-04-27","2019-09-06","2021-09-13","2019-11-13","2021-10-08","2020-01-13","2021-10-08","2020-01-13","2020-02-21","2020-08-23","2020-04-13","2020-02-21","2020-02-21","2020-02-22","2020-02-22","2020-05-15","2020-05-05","2020-06-09","2020-07-30","2021-04-16","2020-06-09","2020-09-29","2020-11-13","2020-09-02","2020-09-30","2021-01-13","2021-01-13","2020-12-12","2020-12-12","2020-12-12","2021-03-01","2021-04-07","2021-04-27","2020-02-04","2020-02-04","2020-02-21","2020-05-07","2021-04-07","2019-09-03","2019-10-23","2019-10-23","2019-10-23","2019-10-23","2019-09-03","2021-11-11","2021-10-27","2020-01-27","2020-01-27","2021-04-16","2020-02-21","2020-05-05","2020-06-10","2019-09-03","2019-10-07","2019-10-23","2019-10-23","2019-10-23","2020-02-21","2020-07-26","2020-07-25","2020-07-16","2020-07-16","2021-10-19","2021-10-19","2021-02-24","2021-02-24","2021-11-11","2021-10-19","2021-08-03","2019-10-23","2021-08-24","2019-11-13","2020-08-23","2020-08-23","2020-08-23","2020-08-24","2020-10-07","2021-09-27","2020-11-03","2020-11-13","2021-10-08","2020-12-08","2020-11-23","2021-04-20","2019-10-24","2020-01-17","2020-02-10","2020-02-10","2020-08-23","2020-09-30","2020-10-19","2020-10-19","2020-10-19","2020-12-08","2021-09-13","2021-02-25","2020-07-30","2020-07-30","2021-04-29","2021-04-16","2021-10-08","2021-04-16","2021-04-22","2021-04-22","2021-04-24","2021-10-26","2021-08-31","2021-11-16","2021-10-08","2021-10-08","2021-10-08","2021-10-08","2021-10-09","2021-08-24","2021-09-14","2021-09-13","2021-10-26","2021-10-26","2021-08-20","2021-10-08","2021-11-11","2021-10-08","2021-11-18"],"priorHcc":["",null,"","",null,"","",null,"","",null,null,null,null,null,null,null,null,"",null,"","",null,null,null,null,null,null,null,"","","","","",null,null,null,"",null,null,"","",null,null,null,null,null,"",null,null,"","",null,"","","",null,"",null,null,"",null,"",null,null,"","",null,null,"",null,null,"",null,null,"","","","","","",null,"","","","","","","","","","",null,"",null,"",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,null,"","","","","","","","","","","","","","","","",null,null,"","",null,null,"","",null,"","","","","","",null,"","",null,"","","","","","","","","","","","","",null,"","","","","",null,"","","","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null]}},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","16729022517","SPIRONOLACT","TAB 25MG","180","Select","Select",""],["","50228013690","LEVOCETIRIZI","TAB 5MG","30","Select","Select",""],["","43547040350","FUROSEMIDE","TAB 80MG","225","Select","Select",""],["","24979002602","DILTIAZEM","CAP 120MG ER","90","Select","Select",""],["","80681016900","VITAMIN D3","TAB 25MCG","60","Select","Select",""],["","69238106501","POT CHLORIDE","TAB 10MEQ ER","90","Select","Select",""],["","57237023305","SMZ-TMP DS","TAB 800-160","30","Select","Select",""],["","67877021901","CEPHALEXIN","CAP 500MG","21","Select","Select",""],["","536106210","STOOL SOFTNR","CAP 100MG","180","Select","Select",""],["","57237012501","WARFARIN","TAB 6MG","30","Select","Select",""],["","31722094901","OXYCOD\/APAP","TAB 5-325MG","30","Select","Select",""],["","14539070201","BUMETANIDE","TAB 2MG","60","Select","Select",""],["","832532411","POT CL MICRO","TAB 10MEQ ER","30","Select","Select",""],["","169266015","TRESIBA FLEX","INJ 100UNIT","-21","Select","Select",""],["","761022020","SENNA LAX","TAB 8.6MG","60","Select","Select",""],["","23155002305","BUSPIRONE","TAB 5MG","90","Select","Select",""],["","85461001","DULERA","AER 200-5MCG","13","Select","Select",""],["","23155010410","METFORMIN","TAB 1000MG","60","Select","Select",""],["","76204090025","LEVALBUTEROL","NEB 1.25MG","75","Select","Select",""],["","761016840","VITAMIN D-3","TAB 2000UNIT","30","Select","Select",""],["","52817036000","METOPROL TAR","TAB 25MG","30","Select","Select",""],["","53885027150","ONETOUCH","TES VERIO","100","Select","Select",""],["","2751001","HUMALOG","INJ 100\/ML","10","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","60505258008","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","54004641","IPRATROPIUM","SPR 0.0006","15","Select","Select",""],["","69238183901","LEVOTHYROXIN","TAB 175MCG","90","Select","Select",""],["","37205011278","GAS RELIEF","CHW 80MG","60","Select","Select",""],["","172572860","FAMOTIDINE","TAB 20MG","180","Select","Select",""],["","10135020301","SIMETHICONE","CHW 80MG","60","Select","Select",""],["","90166015655","INSULIN SYRG","MIS 0.5\/31G","100","Select","Select",""],["","60505619600","ERTAPENEM","INJ 1GM","5","Select","Select",""],["","338004904","SOD CHLORIDE","INJ 0.009","1000","Select","Select",""],["","57896087601","VITAMIN D","TAB 1000UNIT","60","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","100","Select","Select",""],["","90166043154","PEN NEEDLES","MIS 32GX4MM","300","Select","Select",""],["","63323053784","ENOXAPARIN","INJ 150MG\/ML","10","Select","Select",""],["","65862019805","GABAPENTIN","CAP 100MG","30","Select","Select",""],["","65862056099","PANTOPRAZOLE","TAB 40MG","60","Select","Select",""],["","66733077301","INSULIN LISP","INJ 100\/ML","-20","Select","Select",""],["","67405065105","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","30","Select","Select",""],["","60432026415","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","65162004710","OXYCODONE","TAB 5MG","20","Select","Select",""],["","69452010532","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","45802086803","POLYETH GLYC","POW 3350 NF","510","Select","Select",""],["","54001729","PREDNISONE","TAB 10MG","20","Select","Select",""],["","536250676","SALINE MIST","SPR 0.0065","44","Select","Select",""],["","3089421","ELIQUIS","TAB 5MG","180","Select","Select",""],["","2143380","TRULICITY","INJ 0.75\/0.5","2","Select","Select",""],["","2879959","HUMALOG KWIK","INJ 100\/ML","75","Select","Select",""],["","173068220","VENTOLIN HFA","AER ","18","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","185505001","METOLAZONE","TAB 2.5MG","30","Select","Select",""],["","65862056090","PANTOPRAZOLE SODIUM","","30","Select","Select",""],["","16729022516","SPIRONOLACTONE","","30","Select","Select",""],["","52817036000","METOPROLOL TARTRATE","","180","Select","Select",""],["","90166015655","GLOBAL INJECT EASE INSULIN SYRINGE\/U-100\/0.5ML\/31G X 5\/16\"","","90","Select","Select",""],["","62037099905","POTASSIUM CHLORIDE ER","","60","Select","Select",""],["","69238183901","LEVOTHYROXINE SODIUM ","","90","Select","Select",""],["","76204090025","LEVALBUTEROL HCL","","-72","Select","Select",""],["","90166015615","GLOBAL INJECT EASE INSULIN SYRINGE\/U-100\/1ML\/31G X 5\/16\"","","-90","Select","Select",""],["","45802086803","POLYETHYLENE GLYCOL 3350","","510","Select","Select",""],["","57237012601","WARFARIN SODIUM ","","90","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","","18","Select","Select",""],["","23155010410","METFORMIN HYDROCHLORIDE","","180","Select","Select",""],["","169266015","TRESIBA FLEXTOUCH","","15","Select","Select",""],["","31722094901","OXYCODONE\/ACETAMINOPHEN","","30","Select","Select",""],["","69452010532","MONTELUKAST SODIUM ","","90","Select","Select",""],["","23155002305","BUSPIRONE HYDROCHLORIDE","","90","Select","Select",""],["","2751001","HUMALOG ","","10","Select","Select",""],["","67405065105","DOXYCYCLINE HYCLATE","","20","Select","Select",""],["","54004641","IPRATROPIUM BROMIDE","","15","Select","Select",""],["","66733077301","INSULIN LISPRO","","-20","Select","Select",""],["","536106210","STOOL SOFTENER","","180","Select","Select",""],["","50228013690","LEVOCETIRIZINE DIHYDROCHLORIDE","","30","Select","Select",""],["","90166043154","GLOBAL EASE INJECT PEN NEEDLES 32GX4MM","","100","Select","Select",""],["","57896087601","VITAMIN D ","","180","Select","Select",""],["","53885000810","ONETOUCH DELICA PLUS LANCETS EXTRA FINE 33G ","","-100","Select","Select",""],["","53885027150","ONETOUCH VERIO TEST STRIPS","","100","Select","Select",""],["","53885026701","ONETOUCH VERIO IQ BLOOD GLUCOSE MONITORING SYSTEM ","","1","Select","Select",""],["","16714087601","ATORVASTATIN CALCIUM ","","-30","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE","","16","Select","Select",""],["","761022020","NATURAL SENNA LAXATIVE","","60","Select","Select",""],["","47781030301","NITROFURANTOIN MONOHYDRATE\/MACROCRYSTALS","","14","Select","Select",""],["","63323053784","ENOXAPARIN SODIUM","","-10","Select","Select",""],["","65162004710","OXYCODONE HYDROCHLORIDE","","20","Select","Select",""],["","24979002602","DILTIAZEM HYDROCHLORIDE ER","","90","Select","Select",""],["","2879959","HUMALOG KWIKPEN ","","75","Select","Select",""],["","536333401","VITAMIN D-1000","","60","Select","Select",""],["","3089421","ELIQUIS ","","180","Select","Select",""],["","487950125","ALBUTEROL SULFATE","","225","Select","Select",""],["","57237023305","SULFAMETHOXAZOLE\/TRIMETHOPRIM DS","","30","Select","Select",""],["","2143380","TRULICITY ","","2","Select","Select",""],["","60505619604","ERTAPENEM SODIUM","","-7","Select","Select",""],["","55150028220","ERTAPENEM ","","-7","Select","Select",""],["","338004904","SODIUM CHLORIDE ","","500","Select","Select",""],["","172541146","FLUCONAZOLE","","10","Select","Select",""],["","69238183801","LEVOTHYROXINE SODIUM","","90","Select","Select",""],["","57237012601","WARFARIN SODIUM","","30","Select","Select",""],["","69452010532","MONTELUKAST SODIUM","","90","Select","Select",""],["","53885026701","ONETOUCH VERIO IQ BLOOD GLUCOSE MONITORING SYSTEM","","1","Select","Select",""],["","53885000810","ONETOUCH DELICA PLUS LANCETS EXTRA FINE 33G","","-100","Select","Select",""],["","60505258008","ATORVASTATIN CALCIUM","","30","Select","Select",""],["","00002879959","HUMALOG KWIKPEN","","75","Select","Select",""],["","00338004904","SODIUM CHLORIDE","","1000","Select","Select",""],["","60505083305","AZELASTINE HYDROCHLORIDE","0.10%","30","Select","Select",""],["","68682036790","DILTIAZEM HCL ER","120MG\/24","-90","Select","Select",""],["","00143992801","CIPROFLOXACIN HYDROCHLORIDE","500MG","14","Select","Select",""],["","00904699880","DOCUSATE SODIUM","100MG","180","Select","Select",""],["","65862064290","AZITHROMYCIN","500MG","10","Select","Select",""],["","57237012401","WARFARIN SODIUM                                                       ","TAB 5MG","30","Select","Select",""],["","00536106210","STOOL SOFTENER                                                        ","CAP 100MG","180","Select","Select",""],["","53885000810","ONETOUCH DELICA PLUS LANCETS EXTRA FINE 33G                           ","MIS PLUS 33G","-100","Select","Select",""],["","00169266015","TRESIBA FLEXTOUCH                                                     ","INJ 100UNIT","3","Select","Select",""],["","23155002305","BUSPIRONE HYDROCHLORIDE                                               ","TAB 5MG","90","Select","Select",""],["","16714087601","ATORVASTATIN CALCIUM                                                  ","TAB 40MG","-30","Select","Select",""],["","53885026701","ONETOUCH VERIO IQ BLOOD GLUCOSE MONITORING SYSTEM                     ","KIT VERIO IQ","1","Select","Select",""],["","53885027150","ONETOUCH VERIO TEST STRIPS                                            ","TES VERIO","150","Select","Select",""],["","65862056099","PANTOPRAZOLE SODIUM                                                   ","TAB 40MG","60","Select","Select",""],["","31722094901","OXYCODONE\/ACETAMINOPHEN                                               ","TAB 5-325MG","30","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA                                                 ","AER HFA","18","Select","Select",""],["","00761022020","NATURAL SENNA LAXATIVE                                                ","TAB 8.6MG","60","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE                                                ","SPR 50MCG","16","Select","Select",""],["","00832532411","POTASSIUM CHLORIDE ER                                                 ","TAB 10MEQ ER","30","Select","Select",""],["","23155010410","METFORMIN HYDROCHLORIDE                                               ","TAB 1000MG","60","Select","Select",""],["","16729022517","SPIRONOLACTONE                                                        ","TAB 25MG","60","Select","Select",""],["","00173068220","VENTOLIN HFA                                                          ","AER ","18","Select","Select",""],["","50228013690","LEVOCETIRIZINE DIHYDROCHLORIDE                                        ","TAB 5MG","30","Select","Select",""],["","10135020301","SIMETHICONE                                                           ","CHW 80MG","60","Select","Select",""],["","69238183901","LEVOTHYROXINE SODIUM                                                  ","TAB 175MCG","90","Select","Select",""],["","00002751001","HUMALOG                                                               ","INJ 100\/ML","20","Select","Select",""],["","47781030301","NITROFURANTOIN MONOHYDRATE\/MACROCRYSTALS                              ","CAP 100MG","14","Select","Select",""],["","37205011278","GAS RELIEF                                                            ","CHW 80MG","60","Select","Select",""],["","14539070201","BUMETANIDE                                                            ","TAB 2MG","60","Select","Select",""],["","00085461001","DULERA                                                                ","AER 200-5MCG","13","Select","Select",""],["","63323053784","ENOXAPARIN SODIUM                                                     ","INJ 150MG\/ML","-10","Select","Select",""],["","00904615760","VITAMIN D                                                             ","TAB 2000UNIT","30","Select","Select",""],["","76204090025","LEVALBUTEROL HCL                                                      ","NEB 1.25MG","75","Select","Select",""],["","00172572860","FAMOTIDINE                                                            ","TAB 20MG","60","Select","Select",""],["","00761016840","VITAMIN D-3                                                           ","TAB 2000UNIT","30","Select","Select",""],["","52817036000","METOPROLOL TARTRATE                                                   ","TAB 25MG","30","Select","Select",""],["","90166015655","GLOBAL INJECT EASE INSULIN SYRINGE\/U-100\/0.5ML\/31G X 5\/16\"            ","MIS 0.5\/31G","100","Select","Select",""],["","67877021901","CEPHALEXIN                                                            ","CAP 500MG","21","Select","Select",""],["","43547040350","FUROSEMIDE                                                            ","TAB 80MG","90","Select","Select",""],["","00054004641","IPRATROPIUM BROMIDE                                                   ","SPR 0.0006","15","Select","Select",""],["","00002879959","HUMALOG KWIKPEN                                                       ","INJ 100\/ML","75","Select","Select",""],["","65162004710","OXYCODONE HYDROCHLORIDE                                               ","TAB 5MG","20","Select","Select",""],["","65862019805","GABAPENTIN                                                            ","CAP 100MG","30","Select","Select",""],["","90166043154","GLOBAL EASE INJECT PEN NEEDLES 32GX4MM                                ","MIS 32GX4MM","300","Select","Select",""],["","00536333401","VITAMIN D-1000                                                        ","TAB 1000UNIT","60","Select","Select",""],["","24979002602","DILTIAZEM HYDROCHLORIDE ER                                            ","CAP 120MG ER","90","Select","Select",""],["","00185505001","METOLAZONE                                                            ","TAB 2.5MG","30","Select","Select",""],["","00487950125","ALBUTEROL SULFATE                                                     ","NEB 0.00083","225","Select","Select",""],["","80681016900","VITAMIN D3                                                            ","TAB 25MCG","60","Select","Select",""],["","57237023305","SULFAMETHOXAZOLE\/TRIMETHOPRIM DS                                      ","TAB 800-160","30","Select","Select",""],["","00003089421","ELIQUIS                                                               ","TAB 5MG","180","Select","Select",""],["","00172541146","FLUCONAZOLE                                                           ","TAB 100MG","10","Select","Select",""],["","90166015615","GLOBAL INJECT EASE INSULIN SYRINGE\/U-100\/1ML\/31G X 5\/16\"              ","MIS 1ML\/31G","200","Select","Select",""],["","00002143380","TRULICITY                                                             ","INJ 0.75\/0.5","2","Select","Select",""],["","55150028220","ERTAPENEM                                                             ","INJ 1GM","7","Select","Select",""],["","60505619600","ERTAPENEM SODIUM                                                      ","INJ 1GM","5","Select","Select",""],["","16729011917","MONTELUKAST SODIUM                                                    ","TAB 10MG","30","Select","Select",""],["","00338004904","SODIUM CHLORIDE                                                       ","INJ 0.009","1000","Select","Select",""],["","00143992801","CIPROFLOXACIN HYDROCHLORIDE                                           ","TAB 500MG","14","Select","Select",""],["","00904699880","DOCUSATE SODIUM                                                       ","CAP 100MG","180","Select","Select",""],["","68682036790","DILTIAZEM HCL ER                                                      ","CAP 120MG\/24","90","Select","Select",""],["","60505083305","AZELASTINE HYDROCHLORIDE                                              ","SPR 0.001","30","Select","Select",""],["","65862064290","AZITHROMYCIN                                                          ","TAB 500MG","10","Select","Select",""],["","00088222033","LANTUS                                                                ","INJ 100\/ML","30","Select","Select",""],["","00002773701","INSULIN LISPRO                                                        ","INJ 100\/ML","10","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}