{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"IRMA WANDEMBERG","gend":1,"add":"11631 WOMACK STREET","city":"CHESTER","state":"VA","zip":"23831-1648","dob":"1942-08-09","age":"","mstatus":"","insh":"11008287","cliId":"","pno":8049141624,"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":"11631 WOMACK STREET","madd2":"","madd3":"","mcity":"CHESTER","mstate":"VA","mzip":"23831-1648","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":[["","00487950160","ALBUTEROL ","0.08%","180.00","Select","Select",""],["","68462019005","NAPROXEN ","500MG","60.00","Select","Select",""],["","16729031701","OXYBUTYNIN ","5MG ER","90.00","Select","Select",""],["","57664047758","METOPROL ","50MG","60.00","Select","Select",""],["","57237004705","DIVALPROEX ","250MG DR","60.00","Select","Select",""],["","00003089421","ELIQUIS ","5MG","60.00","Select","Select",""],["","43547034250","RISPERIDONE ","2MG","30.00","Select","Select",""],["","00054429931","FUROSEMIDE ","40MG","30.00","Select","Select",""],["","00115164501","NITROFUR ","100MG","30.00","Select","Select",""],["","65162062711","TRAMADOL ","50MG","14.00","Select","Select",""],["","65862090801","CELECOXIB ","100MG","180.00","Select","Select",""],["","66685100100","AMOX\/K ","875-125","20.00","Select","Select",""],["","24208079535","NEO\/POLY\/DEX ","0.1% OP","3.50","Select","Select",""],["","00228253910","CARB\/LEVO ","25-100MG","9.00","Select","Select",""],["","00713022515","TRIAMCINOLON ","0.10%","15.00","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","20.00","Select","Select",""],["","00143992701","CIPROFLOXACN ","250MG","6.00","Select","Select",""],["","65862017760","CEFDINIR ","300MG","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":["",""]}},{"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":""}]}]}