{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" R ENAJNITRAM","gend":1,"add":"HCIR 823EVA DNOM","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"1934-09-24","age":"","mstatus":"","insh":"00116574","cliId":"","pno":"0243403943","cno":"","email":"","ename":"","eno":"","pphy":"TURNER, WESLEY CHAD","ppno":4347914122,"pcpadd":"705 Main St","pcpcity":"Danville","pcpstate":"VA","pcpzip":245411803,"pcpcounty":"","pcpid":"","pcpname":"HEALTH CENTER OF PIEDMONT DANVILLE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"328 RICHMOND AVE","madd2":"","madd3":"","mcity":"DANVILLE","mstate":"VA","mzip":"24540-9998","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":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","60846080401","UNITHROID","TAB 88MCG","30.00","Select","Select",""],["","53885024450","ONETOUCH","TES ULTRA BL","300.00","Select","Select",""],["","50111043301","TRAZODONE","TAB 50MG","90.00","Select","Select",""],["","31722051901","HYDRALAZINE","TAB 10MG","90.00","Select","Select",""],["","00378180777","LEVOTHYROXIN","TAB 88MCG","90.00","Select","Select",""],["","56151014401","TRUPLUS","MIS 30G","100.00","Select","Select",""],["","51224011960","GABAPENTIN","CAP 300MG","90.00","Select","Select",""],["","16729000617","SIMVASTATIN","TAB 40MG","90.00","Select","Select",""],["","68382041205","OMEPRAZOLE","CAP 20MG","90.00","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","90.00","Select","Select",""],["","00006027754","JANUVIA","TAB 100MG","90.00","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","15.00","Select","Select",""],["","45802005435","TRIAMCINOLON","OIN 0.00025","30.00","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","45.00","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","6.00","Select","Select",""],["","57664050658","METOPROL","TAB 25MG","60.00","Select","Select",""],["","00005197102","PREVNAR","INJ ","0.50","Select","Select",""],["","49281040565","FLUZONE","INJ PF 19-20","0.50","Select","Select",""],["","00006494300","PNEUMOVAX","INJ 25\/0.5","0.50","Select","Select",""],["","46287000601","SPS","SUS 15GM\/60","240.00","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":""}]}]}