{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CLAUDETTE LEWIS","gend":1,"add":"17408 MALLORYS FORD ROAD","city":"GORDONSVILLE","state":"VA","zip":"22942-8874","dob":"1945-06-11","age":"","mstatus":"","insh":"11002490","cliId":"","pno":5407271056,"cno":5407278568,"email":"","ename":"","eno":"","pphy":"LAFFOND, WILLIAM T","ppno":4346541850,"pcpadd":"2503 S Seminole Trl # 105","pcpcity":"Madison","pcpstate":"VA","pcpzip":227272690,"pcpcounty":"","pcpid":"","pcpname":"MADISON FAMILY MEDICINE INC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"APT 101","add3":"","madd1":"17408 MALLORYS FORD ROAD","madd2":"APT 101","madd3":"","mcity":"GORDONSVILLE","mstate":"VA","mzip":"22942-8874","pcpfaxno":"(434) 654-1850","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":[["","70377002711","ATORVASTATIN ","10MG","90.00","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","90.00","Select","Select",""],["","00172572880","FAMOTIDINE ","20MG","60.00","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","12.00","Select","Select",""],["","00093220305","METOCLOPRAM ","10MG","3.00","Select","Select",""],["","43386006019","GAVILYTE-C ","","4,000.00","Select","Select",""],["","00093117701","NEOMYCIN ","500MG","6.00","Select","Select",""],["","00955100410","ENOXAPARIN ","40\/0.4ML","12.00","Select","Select",""],["","43386009019","GAVILYTE-G ","","4,000.00","Select","Select",""],["","69238148501","ERYTHROMYCIN ","500MG BS","6.00","Select","Select",""],["","00378041510","DIPHEN\/ATROP ","2.5MG","16.00","Select","Select",""],["","00406055201","OXYCODONE ","5MG","5.00","Select","Select",""],["","68180030260","CEFUROXIME ","250MG","3.00","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":""}]}]}