{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VANESSA MIDDLETON","gend":1,"add":"313 B WASHINGTON AVE","city":"FRANKLIN","state":"VA","zip":"23851-1552","dob":"1954-12-01","age":"","mstatus":"","insh":"11003544","cliId":"","pno":7575710041,"cno":7573647428,"email":"","ename":"","eno":"","pphy":"GRAVES, NIKKI L","ppno":7574847248,"pcpadd":"13609 Carrollton Blvd Ste 11","pcpcity":"Carrollton","pcpstate":"VA","pcpzip":233143214,"pcpcounty":"","pcpid":"","pcpname":"NANSEMOND SUFFOLK FAMILY PRACTICE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"313 B WASHINGTON AVE","madd2":"","madd3":"","mcity":"FRANKLIN","mstate":"VA","mzip":"23851-1552","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":[["","69097012715","AMLODIPINE ","5MG","30.00","Select","Select",""],["","29300012810","HYDROCHLOROT ","25MG","30.00","Select","Select",""],["","65862006399","METOPROL ","50MG","30.00","Select","Select",""],["","76282066339","DICLOFENAC ","1%","100.00","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","SENSOR","2.00","Select","Select",""],["","51224010750","METFORMIN ","750MG ER","30.00","Select","Select",""],["","00006022131","JANUVIA ","25MG","30.00","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","READER","1.00","Select","Select",""],["","00378456105","POT  CHLORIDE","10MEQ ER","30.00","Select","Select",""],["","60505014101","GLIPIZIDE ","5MG","15.00","Select","Select",""],["","53885001110","ONETOUCH ","PLUS 30G","100.00","Select","Select",""],["","68462018022","MUPIROCIN ","2%","22.00","Select","Select",""],["","68382005101","MELOXICAM ","15MG","30.00","Select","Select",""],["","49348089610","SM ","PREP","100.00","Select","Select",""],["","00781502207","METHYLPRED ","4MG","21.00","Select","Select",""],["","50111078867","AZITHROMYCIN ","500MG","2.00","Select","Select",""],["","62332001731","METRONIDAZOL ","500MG","4.00","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","1.00","Select","Select",""],["","00093005805","TRAMADOL ","50MG","12.00","Select","Select",""],["","16714069211","FLUCONAZOLE ","150MG","3.00","Select","Select",""],["","23155013525","DOXYCYC ","100MG","14.00","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}