{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JODI PRITTS","gend":1,"add":"19 CASEY ST","city":"CRIMORA","state":"VA","zip":"24431-9998","dob":"1970-12-12","age":"","mstatus":"","insh":"11007040","cliId":"","pno":5409423068,"cno":"","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":"19 CASEY ST","madd2":"","madd3":"","mcity":"CRIMORA","mstate":"VA","mzip":"24431-9998","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":[["","16714079801","SUMATRIPTAN ","100MG","9.00","Select","Select",""],["","49884093547","DICLOFENAC ","1%","400.00","Select","Select",""],["","55111068010","FONDAPARINUX ","7.5\/0.6","18.00","Select","Select",""],["","69238120402","BUPRENORPHIN ","15MCG\/HR","4.00","Select","Select",""],["","69097094312","GABAPENTIN ","300MG","112.00","Select","Select",""],["","10702001801","OXYCODONE ","5MG","28.00","Select","Select",""],["","55111053301","DIVALPROEX ","250MG ER","60.00","Select","Select",""],["","69097022416","ALENDRONATE ","70MG","12.00","Select","Select",""],["","00832105515","BACLOFEN ","20MG","84.00","Select","Select",""],["","00527058601","DICYCLOMINE ","10MG","180.00","Select","Select",""],["","60505132101","MIDODRINE ","5MG","180.00","Select","Select",""],["","54838051240","DOXEPIN ","10MG\/ML","10.00","Select","Select",""],["","68382080601","TRAZODONE ","100MG","90.00","Select","Select",""],["","00781261305","AMOXICILLIN ","500MG","30.00","Select","Select",""],["","51991074890","DULOXETINE ","60MG","28.00","Select","Select",""],["","10702020101","OXYBUTYNIN ","5MG","90.00","Select","Select",""],["","59746011306","PROCHLORPER ","5MG","30.00","Select","Select",""],["","60505004206","ACYCLOVIR ","200MG","50.00","Select","Select",""],["","57237007710","ONDANSETRON ","4MG ODT","30.00","Select","Select",""],["","49281072010","FLUBLOK ","2020-21","0.50","Select","Select",""],["","69547035302","NARCAN ","","2.00","Select","Select",""],["","59011075804","BUTRANS ","15MCG\/HR","4.00","Select","Select",""],["","69097012203","TOPIRAMATE ","25MG","120.00","Select","Select",""],["","00143924920","AMOX\/K ","875-125","14.00","Select","Select",""],["","68180096301","ALBUTEROL ","HFA","8.50","Select","Select",""],["","59310057922","PROAIR ","","8.50","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":""}]}]}