{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LARRY G SEARS","gend":0,"add":"25 CHURCHVILLE LOOP","city":"CHURCHVILLE","state":"VA","zip":"24421-9998","dob":"1982-01-11","age":"","mstatus":"","insh":"11005465","cliId":"","pno":5403376656,"cno":5404486440,"email":"","ename":"","eno":"","pphy":"YOUNG, SCOTT F","ppno":5409498241,"pcpadd":"428 S Magnolia Ave Ste 1","pcpcity":"Waynesboro","pcpstate":"VA","pcpzip":229803629,"pcpcounty":"","pcpid":"","pcpname":"CFM ASSOCIATED PHYSICIANS WAYNESBORO","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"25 CHURCHVILLE LOOP","madd2":"","madd3":"","mcity":"CHURCHVILLE","mstate":"VA","mzip":"24421-9998","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":[["","42543040701","POT  CITRATE ","1080MG","120.00","Select","Select",""],["","17478071110","LIDOCAINE ","2% JELLY","30.00","Select","Select",""],["","50383024116","LEVETIRACETA ","100MG\/ML","600.00","Select","Select",""],["","54838055080","RANITIDINE ","75MG\/5ML","1,200.00","Select","Select",""],["","69097086107","ZONISAMIDE ","100MG","90.00","Select","Select",""],["","65862053750","LEVOFLOXACIN ","500MG","10.00","Select","Select",""],["","00574200802","NYSTOP ","100000","60.00","Select","Select",""],["","76204010060","IPRATROPIUM ","0.02%INH","300.00","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16.00","Select","Select",""],["","00172572860","FAMOTIDINE ","20MG","180.00","Select","Select",""],["","76204020025","ALBUTEROL ","0.08%","300.00","Select","Select",""],["","52817018000","CLONIDINE ","0.1MG","180.00","Select","Select",""],["","62037099901","POT  CL MICRO","20MEQ ER","90.00","Select","Select",""],["","68382053701","POT  CITRA ER","1080MG","120.00","Select","Select",""],["","60432053760","NYSTATIN ","100000","60.00","Select","Select",""],["","68382013201","TAMSULOSIN ","0.4MG","90.00","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","21.00","Select","Select",""],["","00781808926","AZITHROMYCIN ","250MG","6.00","Select","Select",""],["","57237005920","CEFUROXIME ","500MG","20.00","Select","Select",""],["","45963043965","CONSTULOSE ","10GM\/15","1,892.00","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","14.00","Select","Select",""],["","66685100100","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":["",""],"sub":{"indx":[["","",""],[""],[""],[""],[""]],"comment":[["","",""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}