{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JEFFREY GORDON","gend":0,"add":"5930 QUEENS THORPE CT","city":"RICHMOND","state":"VA","zip":"23227-9998","dob":"1974-03-21","age":"","mstatus":"","insh":"11001539","cliId":"","pno":8043297830,"cno":"","email":"","ename":"","eno":"","pphy":"COVINGTON, DAMIAN L","ppno":8042257177,"pcpadd":"11020 HULL STREET RD","pcpcity":"MIDLOTHIAN","pcpstate":"VA","pcpzip":231123200,"pcpcounty":"","pcpid":"","pcpname":"DOMINION MEDICAL ASSOCIATES INC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"APT 208","add3":"","madd1":"5930 QUEENS THORPE CT","madd2":"APT 208","madd3":"","mcity":"RICHMOND","mstate":"VA","mzip":"23227-9998","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":[["","00143993905","AMOXICILLIN ","500MG","21.00","Select","Select",""],["","68462019005","NAPROXEN ","500MG","180.00","Select","Select",""],["","61314063136","NEO\/POLY\/DEX ","0.1% OP","3.50","Select","Select",""],["","51672128902","NYSTATIN ","100000","60.00","Select","Select",""],["","69547035302","NARCAN ","","2.00","Select","Select",""],["","68180071909","AMLODIPINE ","2.5MG","90.00","Select","Select",""],["","00527169505","BUT\/APAP\/CAF ","","40.00","Select","Select",""],["","24208055555","BACIT\/POLYMY ","OP","3.50","Select","Select",""],["","10702000350","PROMETHAZINE ","25MG","20.00","Select","Select",""],["","42571016242","AMOX\/K ","875-125","20.00","Select","Select",""],["","00406324301","HYDROMORPHON ","2MG","20.00","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":""}]}]}