{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARY GATLING","gend":1,"add":"7380 ROLF HWY","city":"DENDRON","state":"VA","zip":"23839-9998","dob":"1943-05-20","age":"","mstatus":"","insh":"11001851","cliId":"","pno":7572943680,"cno":"","email":"","ename":"","eno":"","pphy":"COLEMAN, GEORGE C","ppno":8048348871,"pcpadd":"344 W Main St","pcpcity":"Waverly","pcpstate":"VA","pcpzip":238903235,"pcpcounty":"","pcpid":"","pcpname":"IVOR MEDICAL CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"7380 ROLF HWY","madd2":"","madd3":"","mcity":"DENDRON","mstate":"VA","mzip":"23839-9998","pcpfaxno":"(804) 834-8875","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":[["","00003089421","ELIQUIS ","5MG","30.00","Select","Select",""],["","58406004404","ENBREL ","50MG\/ML","4.00","Select","Select",""],["","49884078711","OLM ","\/HCTZ","30.00","Select","Select",""],["","00054455015","METHOTREXATE ","2.5MG","72.00","Select","Select",""],["","00378180377","LEVOTHYROXIN ","50MCG","30.00","Select","Select",""],["","70010049101","METFORMIN ","ORAL TAB","180.00","Select","Select",""],["","68382009301","CARVEDILOL ","6.25MG","60.00","Select","Select",""],["","69238149001","BUMETANIDE ","1MG","30.00","Select","Select",""],["","65162062710","TRAMADOL ","50MG","30.00","Select","Select",""],["","57237010299","METOPROL ","100MG","180.00","Select","Select",""],["","13668010401","ISOSORB ","30MG ER","90.00","Select","Select",""],["","00185505001","METOLAZONE ","2.5MG","30.00","Select","Select",""],["","68462063945","NITROGLYCERN ","0.4MG","25.00","Select","Select",""],["","72647033104","METHYLPRED ","4MG","21.00","Select","Select",""],["","00088221905","LANTUS ","100\/ML","15.00","Select","Select",""],["","00597015230","JARDIANCE ","10MG","30.00","Select","Select",""],["","08290320122","BD  PEN NEEDL","32GX4MM","100.00","Select","Select",""],["","59746017206","PREDNISONE ","5MG","30.00","Select","Select",""],["","00409798302","SOD ","0.90%","250.00","Select","Select",""],["","65162083366","DICLOFENAC ","1%","300.00","Select","Select",""],["","69238106501","POT  CHLORIDE","10MEQ ER","30.00","Select","Select",""],["","57894003001","REMICADE ","100MG","8.00","Select","Select",""],["","43547027509","DONEPEZIL ","5MG","30.00","Select","Select",""],["","00832532411","POT  CL MICRO","10MEQ ER","30.00","Select","Select",""],["","58160082311","SHINGRIX ","50MCG","1.00","Select","Select",""],["","65162071009","COLCHICINE ","0.6MG","7.00","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":""}]}]}