{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PAUL MORGAN","gend":0,"add":"2203 COTTNWOOD LAND","city":"CULPEPER","state":"VA","zip":"22701-9998","dob":"1944-09-13","age":"","mstatus":"","insh":"11004188","cliId":"","pno":5408252125,"cno":"","email":"","ename":"","eno":"","pphy":"LAFFOND, WILLIAM T","ppno":4346541850,"pcpadd":"2503 S Seminole Trl # 105","pcpcity":"Madison","pcpstate":"VA","pcpzip":227272690,"pcpcounty":"","pcpid":"","pcpname":"MARTHA JEFFERSON MEDICAL ASSOCIATES","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"2203 COTTNWOOD LAND","madd2":"","madd3":"","mcity":"CULPEPER","mstate":"VA","mzip":"22701-9998","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":[["","70377000415","SIMVASTATIN ","40MG","30.00","Select","Select",""],["","10370010150","BUPROPN ","150MG XL","90.00","Select","Select",""],["","69097081312","GABAPENTIN ","100MG","540.00","Select","Select",""],["","13668013701","ESCITALOPRAM ","20MG","90.00","Select","Select",""],["","53746054401","PRIMIDONE ","50MG","540.00","Select","Select",""],["","00603497528","OXYBUTYNIN ","5MG","90.00","Select","Select",""],["","00597002402","COMBIVENT ","20-100","4.00","Select","Select",""],["","23155000810","HYDROCHLOROT ","25MG","45.00","Select","Select",""],["","00168008031","HYDROCORT ","2.50%","30.00","Select","Select",""],["","10702001801","OXYCODONE ","5MG","20.00","Select","Select",""],["","70436015301","POT  CHLORIDE","20MEQ ER","30.00","Select","Select",""],["","00245531911","KLOR-CON ","20MEQ ER","30.00","Select","Select",""],["","57664049983","MIRTAZAPINE ","15MG","90.00","Select","Select",""],["","13107008405","LORAZEPAM ","1MG","15.00","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":""}]}]}