{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LEROY COOK","gend":0,"add":"507 MOSELEY LN","city":"SOUTH HILL","state":"VA","zip":"23970-9998","dob":"1948-04-28","age":"","mstatus":"","insh":"11005886","cliId":"","pno":4349179444,"cno":4344478328,"email":"","ename":"","eno":"","pphy":"WEIDMAN, PAUL DANIEL","ppno":"   ","pcpadd":"420 Durant St","pcpcity":"South Hill","pcpstate":"VA","pcpzip":239701614,"pcpcounty":"","pcpid":"","pcpname":"CMH PHYSICIAN SERVICES LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1301 HIGH AVE","madd2":"","madd3":"","mcity":"HOPEWELL","mstate":"VA","mzip":"23860-9998","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":[["","68645055354","LISINOPRIL ","20MG","90.00","Select","Select",""],["","00143145005","PHENOBARB ","30MG","60.00","Select","Select",""],["","65862031560","LEVETIRACETA ","1000MG","90.00","Select","Select",""],["","16714035201","FLUOXETINE ","20MG","90.00","Select","Select",""],["","16714004211","ALLOPURINOL ","300MG","90.00","Select","Select",""],["","59762033302","LATANOPROST ","0.01%","2.50","Select","Select",""],["","68645056854","ATORVASTATIN ","40MG","90.00","Select","Select",""],["","65862035705","CLOPIDOGREL ","75MG","90.00","Select","Select",""],["","00093306406","ASA\/DIPYRIDA ","25-200MG","30.00","Select","Select",""],["","68682065220","DIAZEPAM ","10MG","1.00","Select","Select",""],["","00187065820","DIASTAT ","5-10MG","1.00","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":""}]}]}