{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JACOB ROBERTSON","gend":0,"add":"1617 DAM TOWM ROAD","city":"FORT DEFIANCE","state":"VA","zip":"24437-2103","dob":"1994-07-30","age":"","mstatus":"","insh":"11001294","cliId":"","pno":5402927192,"cno":"","email":"","ename":"","eno":"","pphy":"BUCKWALTER, VICTOR LEE","ppno":5404334913,"pcpadd":"1151 Keezletown Rd Ste 101","pcpcity":"Weyers Cave","pcpstate":"VA","pcpzip":244862337,"pcpcounty":"","pcpid":"","pcpname":"CARILION FAMILY MEDICINE WEYERS CAVE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1617 DAM TOWM ROAD","madd2":"","madd3":"","mcity":"FORT DEFIANCE","mstate":"VA","mzip":"24437-2103","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":[["","59417010310","VYVANSE ","30MG","30.00","Select","Select",""],["","67877022205","GABAPENTIN ","100MG","90.00","Select","Select",""],["","13668008190","MONTELUKAST ","10MG","30.00","Select","Select",""],["","57237001899","DULOXETINE ","30MG","90.00","Select","Select",""],["","00591024101","LORAZEPAM ","1MG","10.00","Select","Select",""],["","59762371903","ALPRAZOLAM ","0.25MG","30.00","Select","Select",""],["","00378064110","PREDNISONE ","10MG","7.00","Select","Select",""],["","59310057922","PROAIR ","","8.50","Select","Select",""],["","51672131200","MUPIROCIN ","2%","22.00","Select","Select",""],["","00093598627","EPINEPHRINE ","0.3MG","2.00","Select","Select",""],["","42571016242","AMOX\/K ","875-125","20.00","Select","Select",""],["","00781808926","AZITHROMYCIN ","250MG","6.00","Select","Select",""],["","68462031417","NYSTAT\/TRIAM ","","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":""}]}]}