{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"A ENEGUEHSIRRAP ","gend":0,"add":"YNAFFIT 8015TRUOC SDOOW ","city":"RICHMOND","state":"VA","zip":"23223-9998","dob":"1955-06-21","age":"","mstatus":"","insh":"10110743","cliId":"","pno":"3740896107","cno":"","email":"","ename":"","eno":"","pphy":"ANSARI, NATHER B","ppno":5407859900,"pcpadd":"1075 GARRISONVILLE RDSte 115","pcpcity":"STAFFORD","pcpstate":"VA","pcpzip":225568600,"pcpcounty":"","pcpid":"","pcpname":"PRIMARY AND URGENT CARE LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"N","ano":"","add2":"","add3":"","madd1":"P.O.BOX 853","madd2":"","madd3":"","mcity":"SANDSTON","mstate":"VA","mzip":"23150-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"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":[["","00832105415","BACLOFEN","TAB 10MG","30.00","Select","Select",""],["","16571020210","DICLOFENAC","TAB 50MG DR","60.00","Select","Select",""],["","13668000801","ZOLPIDEM","TAB 10MG","30.00","Select","Select",""],["","68382005105","MELOXICAM","TAB 15MG","30.00","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16.00","Select","Select",""],["","00172392570","DIAZEPAM","TAB 2MG","30.00","Select","Select",""],["","59746000106","METHYLPRED","TAB 4MG","21.00","Select","Select",""],["","65162019011","NAPROXEN","TAB 500MG","60.00","Select","Select",""],["","65162071009","COLCHICINE","TAB 0.6MG","90.00","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","7.00","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473.00","Select","Select",""],["","16714004211","ALLOPURINOL","TAB 300MG","180.00","Select","Select",""],["","70461012003","FLUAD","INJ 0.5ML","0.50","Select","Select",""],["","45802006435","TRIAMCINOLON","CRE 0.001","15.00","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":""}]}]}