{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HENRY M SCOTT","gend":0,"add":"5946 THREE NOTCH ROAD","city":"LOUISA","state":"VA","zip":"23093-9998","dob":"1977-03-25","age":"","mstatus":"","insh":"11004732","cliId":"","pno":5409673204,"cno":"","email":"","ename":"","eno":"","pphy":"HARKRADER, EDWARD R","ppno":5409672202,"pcpadd":"101 Woolfolk Ave","pcpcity":"Louisa","pcpstate":"VA","pcpzip":230934264,"pcpcounty":"","pcpid":"","pcpname":"LOUISA FAMILY PRACTICE PLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"5946 THREE NOTCH ROAD","madd2":"","madd3":"","mcity":"LOUISA","mstate":"VA","mzip":"23093-9998","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":[["","68382000106","PAROXETINE ","40MG","30.00","Select","Select",""],["","55111025960","ZIPRASIDONE ","80MG","30.00","Select","Select",""],["","68645055654","LISINOP\/HCTZ ","10-12.5","30.00","Select","Select",""],["","00093505898","ATORVASTATIN ","40MG","90.00","Select","Select",""],["","61314030802","AZELASTINE ","0.05%","6.00","Select","Select",""],["","29300022019","MONTELUKAST ","10MG","30.00","Select","Select",""],["","00591079501","DICYCLOMINE ","20MG","60.00","Select","Select",""],["","72305010030","EUTHYROX ","100MCG","30.00","Select","Select",""],["","00228277911","PROPRANOLOL ","80MG ER","90.00","Select","Select",""],["","00527134501","LEVOTHYROXIN ","100MCG","30.00","Select","Select",""],["","51672128402","TRIAMCINOLON ","0.10%","60.00","Select","Select",""],["","00054001825","PREDNISONE ","20MG","6.00","Select","Select",""],["","65862070060","CEFUROXIME ","500MG","20.00","Select","Select",""],["","00832059011","DIPHEN\/ATROP ","","30.00","Select","Select",""],["","00781261305","AMOXICILLIN ","500MG","30.00","Select","Select",""],["","69238110005","DOXYCYCL ","100MG","20.00","Select","Select",""],["","17478071310","OFLOXACIN ","0.3% OP","5.00","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":""}]}]}