{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" AIROTCIVYELIAB B","gend":1,"add":"EPRES 405TEERTS LL","city":"FARMVILLE","state":"VA","zip":"23901-1442","dob":"1948-01-24","age":"","mstatus":"","insh":"10112610","cliId":"","pno":"4543490057","cno":"","email":"","ename":"","eno":"","pphy":"BAVUSO, SALVATORE KARL","ppno":8044625155,"pcpadd":"202 Agee St","pcpcity":"Farmville","pcpstate":"VA","pcpzip":239012617,"pcpcounty":"","pcpid":"","pcpname":"WOODLAND FAMILY PRACTICE LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"504 SERPELL STREET","madd2":"","madd3":"","mcity":"FARMVILLE","mstate":"VA","mzip":"23901-1442","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":[["","69097083512","SERTRALINE","TAB 100MG","135.00","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","90.00","Select","Select",""],["","68180016113","AZITHROMYCIN","TAB 500MG","15.00","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18.00","Select","Select",""],["","00378180010","LEVOTHYROXIN","TAB 25MCG","90.00","Select","Select",""],["","69097081312","GABAPENTIN","CAP 100MG","60.00","Select","Select",""],["","63402091164","BROVANA","NEB 15MCG","120.00","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","48.00","Select","Select",""],["","49502080693","YUPELRI","SOL ","90.00","Select","Select",""],["","66689000802","NYSTATIN","SUS 100000","210.00","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","3.00","Select","Select",""],["","70710113803","FLUCONAZOLE","TAB 100MG","1.00","Select","Select",""],["","70377002911","ATORVASTATIN","TAB 40MG","90.00","Select","Select",""],["","68462041827","LIDOCAINE","OIN 0.05","50.00","Select","Select",""],["","59310057922","PROAIR","AER ","8.50","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20.00","Select","Select",""],["","00173068220","VENTOLIN","AER ","18.00","Select","Select",""],["","00173069600","ADVAIR","AER 250\/50","180.00","Select","Select",""],["","65862053750","LEVOFLOXACIN","TAB 500MG","7.00","Select","Select",""],["","70748025730","ARFORMOTEROL","NEB 15\/2ML","120.00","Select","Select",""],["","65862032904","ALENDRONATE","TAB 70MG","12.00","Select","Select",""],["","68180030360","CEFUROXIME","TAB 500MG","20.00","Select","Select",""],["","00228202950","ALPRAZOLAM","TAB 0.5MG","60.00","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","90.00","Select","Select",""],["","00143122701","DICYCLOMINE","TAB 20MG","30.00","Select","Select",""],["","13107008305","LORAZEPAM","TAB 0.5MG","60.00","Select","Select",""],["","71930005552","APAP\/CODEINE","TAB 300-30MG","14.00","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100.00","Select","Select",""],["","50111043301","TRAZODONE","TAB 50MG","30.00","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","14.00","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":""}]}]}