{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"A ADNERBGNORTSMR","gend":1,"add":"XOB OP9171 ","city":"CLINTWOOD","state":"VA","zip":"24228-1719","dob":"1950-12-21","age":"","mstatus":"","insh":"10114650","cliId":"","pno":"2967244726","cno":"","email":"","ename":"","eno":"","pphy":"DEEL, ROY R","ppno":2769260200,"pcpadd":"364 Hospital Dr, ","pcpcity":"Clintwood","pcpstate":"VA","pcpzip":242286786,"pcpcounty":"","pcpid":"","pcpname":"DICKENSON MEDICAL ASSOCIATES","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"PO BOX 1719","madd2":"","madd3":"","mcity":"CLINTWOOD","mstate":"VA","mzip":"24228-1719","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":[["","60505024808","MIRTAZAPINE","TAB 30MG","90","Select","Select",""],["","00713067831","NYSTATIN","CRE 100000","30","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","48","Select","Select",""],["","27808003703","HYDROCO\/APAP","TAB 10-325MG","90","Select","Select",""],["","63304009005","POT  CHLORIDE","CAP 10MEQ ER","90","Select","Select",""],["","70700026305","LANSOPRAZOLE","CAP 30MG DR","90","Select","Select",""],["","59651018030","LETROZOLE","TAB 2.5MG","90","Select","Select",""],["","50383026505","LOTEPREDNOL","SUS 0.005","5","Select","Select",""],["","33342002208","LEVOFLOXACIN","TAB 500MG","7","Select","Select",""],["","50228043605","NAPROXEN","TAB 500MG","14","Select","Select",""],["","00093321930","KETOCONAZOLE","CRE 0.02","30","Select","Select",""],["","50742017501","ISOSORB","TAB 30MG ER","90","Select","Select",""],["","00093317431","ALBUTEROL","FAT E","8.5","Select","Select",""],["","61314003002","DORZOL\/TIMOL","SOL 22.3-6.8","10","Select","Select",""],["","70069042101","LATANOPROST","SOL 0.00005","2.5","Select","Select",""],["","67877051210","ATORVASTATIN","CAL CIUM ORAL","90","Select","Select",""],["","57841130101","MOVANTIK","TAB 25MG","30","Select","Select",""],["","59310057922","PROAIR","AER ","25.5","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","60","Select","Select",""],["","42571016242","AMOX\/K","TAB 875-125","20","Select","Select",""],["","00456120330","LINZESS","CAP 72MCG","30","Select","Select",""],["","24979003903","METOPROL","TAB 100MG ER","90","Select","Select",""],["","70710113801","FLUCONAZOLE","TAB 100MG","7","Select","Select",""],["","33332042010","AFLURIA","INJ 2020-21","0.5","Select","Select",""],["","00168038360","METRONIDAZOL","LOT 0.0075","59","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","20","Select","Select",""],["","70194000330","TRULANCE","TAB 3MG","30","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":""}]}]}