{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LINIA M WALLACE","gend":1,"add":"1360 JENNIE SCHER RD","city":"HENRICO","state":"VA","zip":"23231-9998","dob":"1951-07-25","age":"","mstatus":"","insh":"11007130","cliId":"","pno":8049861384,"cno":8042222816,"email":"","ename":"","eno":"","pphy":"SPARROW JR, CHARLES K","ppno":8047951144,"pcpadd":"2660 New Market Rd","pcpcity":"Henrico","pcpstate":"VA","pcpzip":232317408,"pcpcounty":"","pcpid":"","pcpname":"CHICKAHOMINY FAMILY PRACTICE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"APT B","add3":"","madd1":"1360 JENNIE SCHER RD","madd2":"APT B","madd3":"","mcity":"HENRICO","mstate":"VA","mzip":"23231-9998","pcpfaxno":"(804) 795-1052","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":[["","00054327099","FLUTICASONE ","50MCG","48.00","Select","Select",""],["","00093317431","ALBUTEROL ","E","8.50","Select","Select",""],["","70461012003","FLUAD ","0.5ML","0.50","Select","Select",""],["","65862085901","FAMOTIDINE ","20MG","60.00","Select","Select",""],["","49483060350","IBUPROFEN ","600MG","90.00","Select","Select",""],["","00378967130","IPRATROPIUM\/ ","ALBUTER","90.00","Select","Select",""],["","00597016061","SPIRIVA ","1.25MCG","4.00","Select","Select",""],["","53885024510","ONETOUCH ","ULTRA BL","100.00","Select","Select",""],["","00378395177","ATORVASTATIN ","20MG","90.00","Select","Select",""],["","69097083412","SERTRALINE ","50MG","30.00","Select","Select",""],["","43547035611","LISINOPRIL ","40MG","90.00","Select","Select",""],["","68180072103","AMLODIPINE ","10MG","90.00","Select","Select",""],["","43386035801","HYDROCO\/APAP ","10-325MG","56.00","Select","Select",""],["","49884093547","DICLOFENAC ","1%","100.00","Select","Select",""],["","45802041954","AMMONIUM ","12%","225.00","Select","Select",""],["","62175061746","PANTOPRAZOLE ","40MG","30.00","Select","Select",""],["","00406324301","HYDROMORPHON ","2MG","30.00","Select","Select",""],["","00074262528","MAVYRET ","100-40MG","84.00","Select","Select",""],["","69547035302","NARCAN ","","2.00","Select","Select",""],["","10370010150","BUPROPN ","150MG XL","90.00","Select","Select",""],["","00093342210","CYCLOBENZAPR ","10MG","30.00","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":["",""],"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":""}]}]}