{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BEATRICE ILESANMI","gend":1,"add":"5120 BURNT OAK TER","city":"NORTH CHESTERFIELD","state":"VA","zip":"23234-9998","dob":"1949-12-14","age":"","mstatus":"","insh":"11004506","cliId":"","pno":8045516803,"cno":8045497153,"email":"","ename":"","eno":"","pphy":"REHMAN, SYED A","ppno":7575362246,"pcpadd":"500 Hioaks RdSte B","pcpcity":"Richmond","pcpstate":"VA","pcpzip":232254061,"pcpcounty":"","pcpid":"","pcpname":"PRIMARY HEALTH GROUP INC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"APT 201","add3":"","madd1":"5120 BURNT OAK TER","madd2":"APT 201","madd3":"","mcity":"NORTH CHESTERFIELD","mstate":"VA","mzip":"23234-9998","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":[["","00173069700","ADVAIR ","500\/50","60.00","Select","Select",""],["","00093317431","ALBUTEROL ","E","8.50","Select","Select",""],["","70461012003","FLUAD ","0.5ML","0.50","Select","Select",""],["","16571020150","DICLOFENAC ","75MG DR","60.00","Select","Select",""],["","00591544210","PREDNISONE ","10MG","25.00","Select","Select",""],["","62037083101","METOPROL ","50MG ER","90.00","Select","Select",""],["","55111012205","ATORVASTATIN ","20MG","90.00","Select","Select",""],["","29300012810","HYDROCHLOROT ","25MG","90.00","Select","Select",""],["","00143980305","DOXYCYCL ","100MG","14.00","Select","Select",""],["","67877021560","CEFUROXIME ","250MG","20.00","Select","Select",""],["","65862020299","LOSARTAN ","50MG","90.00","Select","Select",""],["","68180071909","AMLODIPINE ","2.5MG","90.00","Select","Select",""],["","55111017915","TIZANIDINE ","2MG","30.00","Select","Select",""],["","00781577626","AZITHROMYCIN ","250MG","6.00","Select","Select",""],["","65862009620","CEFPODOXIME ","200MG","14.00","Select","Select",""],["","31722072250","LEVOFLOXACIN ","500MG","10.00","Select","Select",""],["","68180051202","LISINOPRIL ","2.5MG","90.00","Select","Select",""],["","17478029111","CROMOLYN ","4% OP","10.00","Select","Select",""],["","59310057922","PROAIR ","","8.50","Select","Select",""],["","68180071160","CEFDINIR ","300MG","20.00","Select","Select",""],["","31722072690","MONTELUKAST ","10MG","90.00","Select","Select",""],["","00310737020","BUDES\/FORMOT ","160-4.5","10.20","Select","Select",""],["","68462024805","RANITIDINE ","150MG","3.00","Select","Select",""],["","59746000204","METHYLPRED ","8MG","25.00","Select","Select",""],["","00006483702","PNEUMOVAX ","25\/0.5","0.50","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":""}]}]}