{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NELL P CROSS","gend":1,"add":"114 SUMMERCREST AVE","city":"WAYNESBORO","state":"VA","zip":"22980-9998","dob":"1968-09-27","age":"","mstatus":"","insh":"11001794","cliId":"","pno":5409435784,"cno":8044717699,"email":"","ename":"","eno":"","pphy":"CHEEK, KIMBERLY M","ppno":5402457950,"pcpadd":"201 Lew Dewitt Blvd","pcpcity":"Waynesboro","pcpstate":"VA","pcpzip":229801663,"pcpcounty":"","pcpid":"","pcpname":"AUGUSTA HEALTH INTERNAL MEDICINE WAYNESBORO","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"N","ano":"","add2":"APARTMENT 12","add3":"","madd1":"114 SUMMERCREST AVE","madd2":"APARTMENT 12","madd3":"","mcity":"WAYNESBORO","mstate":"VA","mzip":"22980-9998","pcpfaxno":"(540) 245-7951","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":[["","27241005503","ARIPIPRAZOLE ","20MG","30.00","Select","Select",""],["","00006027731","JANUVIA ","100MG","90.00","Select","Select",""],["","33342009607","TENOFOVIR ","300MG","90.00","Select","Select",""],["","68180044907","QUETIAPINE ","300MG","30.00","Select","Select",""],["","13668013701","ESCITALOPRAM ","20MG","30.00","Select","Select",""],["","53885000810","ONETOUCH ","PLUS 33G","100.00","Select","Select",""],["","68180011507","LEVETIRACETA ","1000MG","60.00","Select","Select",""],["","00093506101","HYDROXYZ ","25MG","90.00","Select","Select",""],["","65649030302","XIFAXAN ","550MG","60.00","Select","Select",""],["","13107000305","MIRTAZAPINE ","30MG","30.00","Select","Select",""],["","69238183307","LEVOTHYROXIN ","88MCG","90.00","Select","Select",""],["","59148007280","ABILIFY ","400MG","1.00","Select","Select",""],["","68382005001","MELOXICAM ","7.5MG","30.00","Select","Select",""],["","00193731221","CONTOUR ","NEXT","100.00","Select","Select",""],["","68180063609","ATORVASTATIN ","20MG","90.00","Select","Select",""],["","52268001201","SUPREP ","PREP KIT","354.00","Select","Select",""],["","69238111601","BUSPIRONE ","7.5MG","60.00","Select","Select",""],["","49281071910","FLUBLOK ","2019-20","0.50","Select","Select",""],["","68462015713","ONDANSETRON ","4MG ODT","12.00","Select","Select",""],["","65862029490","ROSUVASTATIN ","10MG","30.00","Select","Select",""],["","61958040101","VIREAD ","300MG","30.00","Select","Select",""],["","00143980305","DOXYCYCL ","100MG","14.00","Select","Select",""],["","00781185220","AMOX\/K ","875-125","14.00","Select","Select",""],["","00781261305","AMOXICILLIN ","500MG","30.00","Select","Select",""],["","68001040008","FLUOXETINE ","20MG","28.00","Select","Select",""],["","00713067831","NYSTATIN ","100000","30.00","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","20.00","Select","Select",""],["","58160082311","SHINGRIX ","50MCG","1.00","Select","Select",""],["","51672129803","KETOCONAZOLE ","2%","60.00","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":""}]}]}