{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOSEPH A BANKS","gend":0,"add":"4712 LIPPINGHAM DR","city":"CHESTER","state":"VA","zip":"23831-9998","dob":"1942-12-17","age":"","mstatus":"","insh":"11007189","cliId":"","pno":8042435606,"cno":"","email":"","ename":"","eno":"","pphy":"LINGLER, KIMBERLY","ppno":8047489071,"pcpadd":"12801 IRON BRIDGE ROAD SUITE 100","pcpcity":"CHESTER","pcpstate":"VA","pcpzip":238310000,"pcpcounty":"","pcpid":"","pcpname":"SOUTHSIDE PHYSICIAN NETWORK LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"4712 LIPPINGHAM DR","madd2":"","madd3":"","mcity":"CHESTER","mstate":"VA","mzip":"23831-9998","pcpfaxno":"(804) 768-8626","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":[["","00186037220","SYMBICORT ","80-4.5","10.20","Select","Select",""],["","49281012065","FLUZONE ","PF 20-21","0.70","Select","Select",""],["","31722088490","ROSUVASTATIN ","20MG","90.00","Select","Select",""],["","00093317431","ALBUTEROL ","E","8.50","Select","Select",""],["","00591544305","PREDNISONE ","20MG","10.00","Select","Select",""],["","65862049501","QUETIAPINE ","400MG","30.00","Select","Select",""],["","00173069600","ADVAIR ","250\/50","60.00","Select","Select",""],["","65862056090","PANTOPRAZOLE ","40MG","90.00","Select","Select",""],["","00310737020","BUDES\/FORMOT ","160-4.5","10.20","Select","Select",""],["","68382013201","TAMSULOSIN ","0.4MG","30.00","Select","Select",""],["","23155013525","DOXYCYC ","100MG","20.00","Select","Select",""],["","00832051200","BETHANECHOL ","25MG","90.00","Select","Select",""],["","76204060030","IPRATROPIUM\/ ","ALBUTER","90.00","Select","Select",""],["","31722072690","MONTELUKAST ","10MG","90.00","Select","Select",""],["","00168000215","TRIAMCINOLON ","0.50%","60.00","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","48.00","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21.00","Select","Select",""],["","67877021620","CEFUROXIME ","500MG","14.00","Select","Select",""],["","65862053750","LEVOFLOXACIN ","500MG","7.00","Select","Select",""],["","65162062711","TRAMADOL ","50MG","12.00","Select","Select",""],["","59310057922","PROAIR ","","8.50","Select","Select",""],["","00781808926","AZITHROMYCIN ","250MG","6.00","Select","Select",""],["","70461012103","FLUAD ","2021-22","0.50","Select","Select",""],["","70954000520","OXYBUTYNIN ","5MG","21.00","Select","Select",""],["","00378932132","WIXELA ","250\/50","60.00","Select","Select",""],["","00093077198","PRAVASTATIN ","10MG","30.00","Select","Select",""],["","16729000517","SIMVASTATIN ","20MG","90.00","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":""}]}]}