{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TRACEY J ROANE","gend":1,"add":"2831 HARRIS HILL ROAD","city":"DUNNSVILLE","state":"VA","zip":"22454-2064","dob":"1971-12-14","age":"","mstatus":"","insh":"11000284","cliId":"","pno":8044430383,"cno":"","email":"","ename":"","eno":"","pphy":"BASHORE, RANDALL T","ppno":4345813271,"pcpadd":"2217 Princess Anne StSte 100-2","pcpcity":"Fredericksburg","pcpstate":"VA","pcpzip":224013359,"pcpcounty":"","pcpid":"","pcpname":"CAROLINE FAMILY PRACTICE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"N","ano":"","add2":"","add3":"","madd1":"2270 Hustle Rd","madd2":"","madd3":"","mcity":"Caret","mstate":"VA","mzip":"22436-2234","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":[]},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","31722071390","PANTOPRAZOLE ","40MG","30.00","Select","Select",""],["","29300011416","LAMOTRIGINE ","200MG","60.00","Select","Select",""],["","68645051054","HYDROCHLOROT ","25MG","30.00","Select","Select",""],["","66993058497","FLUTIC\/SALME ","100\/50","60.00","Select","Select",""],["","64380078706","BUSPIRONE ","7.5MG","180.00","Select","Select",""],["","68180096301","ALBUTEROL ","HFA","8.50","Select","Select",""],["","00054001925","PREDNISONE ","50MG","5.00","Select","Select",""],["","00781577626","AZITHROMYCIN ","250MG","6.00","Select","Select",""],["","31722063231","OSELTAMIVIR ","75MG","10.00","Select","Select",""],["","00781518192","LEVOTHYROXIN ","50MCG","30.00","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","473.00","Select","Select",""],["","00406324401","HYDROMORPHON ","4MG","12.00","Select","Select",""],["","49281041950","FLUZONE ","2019-20","0.50","Select","Select",""],["","59310057922","PROAIR ","","8.50","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":""}]}]}