{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARY G CORNICK","gend":1,"add":"104 CATTAIL LANE","city":"SMITHFIELD","state":"VA","zip":"23430-5926","dob":"1949-08-09","age":"","mstatus":"","insh":"11002805","cliId":"","pno":7373323387,"cno":"","email":"","ename":"","eno":"","pphy":"POPE, SHANNON M M","ppno":7573573331,"pcpadd":"201 Gumwood Dr","pcpcity":"Smithfield","pcpstate":"VA","pcpzip":234306086,"pcpcounty":"","pcpid":"","pcpname":"FAMILY MEDICAL CARE SMITHFIELD PLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"APARTMENT 4","add3":"","madd1":"104 CATTAIL LANE","madd2":"APARTMENT 4","madd3":"","mcity":"SMITHFIELD","mstate":"VA","mzip":"23430-5926","pcpfaxno":"(757) 356-9711","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":[["","00169183711","NOVOLIN ","70\/30","40.00","Select","Select",""],["","31722070110","LOSARTAN ","50MG","30.00","Select","Select",""],["","00591024110","LORAZEPAM ","1MG","60.00","Select","Select",""],["","86227062105","INSULIN ","1ML\/30G","60.00","Select","Select",""],["","45802046564","KETOCONAZOLE ","2%","120.00","Select","Select",""],["","29300024310","AMLODIPINE ","10MG","30.00","Select","Select",""],["","00254200801","COLCHICINE ","0.6MG","15.00","Select","Select",""],["","16729000916","PRAVASTATIN ","20MG","30.00","Select","Select",""],["","43547040111","FUROSEMIDE ","20MG","30.00","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","LITE","100.00","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","LANCETS","100.00","Select","Select",""],["","13668013610","ESCITALOPRAM ","10MG","30.00","Select","Select",""],["","68180029706","DULOXETINE ","40MG","30.00","Select","Select",""],["","65862019399","FLUOXETINE ","20MG","30.00","Select","Select",""],["","16729013516","ALLOPURINOL ","300MG","30.00","Select","Select",""],["","23155010310","METFORMIN ","850MG","60.00","Select","Select",""],["","59746012106","MECLIZINE ","25MG","20.00","Select","Select",""],["","67877021905","CEPHALEXIN ","500MG","6.00","Select","Select",""],["","00781185220","AMOX\/K ","875-125","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":""}]}]}