{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MONICA R SPARROW","gend":1,"add":"131 KINGCADE DR","city":"AMHERST","state":"VA","zip":"24521-9998","dob":"1982-01-23","age":"","mstatus":"","insh":"11008523","cliId":"","pno":4349450478,"cno":"","email":"","ename":"","eno":"","pphy":"ZAMAN, SAMIRA","ppno":4349245348,"pcpadd":"1221 Lee Street 1st Floor","pcpcity":"Charlottesville","pcpstate":"VA","pcpzip":229080001,"pcpcounty":"","pcpid":"","pcpname":"CENTRA MEDICAL GROUP","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"PO BOX 815","madd2":"","madd3":"","mcity":"AMHERST","mstate":"VA","mzip":"24521-9998","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":[["","67877025145","TRIAMCINOLON ","0.10%","454.00","Select","Select",""],["","65862092585","INCASSIA ","0.35MG","84.00","Select","Select",""],["","59746011506","PROCHLORPER ","10MG","60.00","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0.50","Select","Select",""],["","51862088403","CAMILA ","0.35MG","84.00","Select","Select",""],["","68462010910","TOPIRAMATE ","100MG","180.00","Select","Select",""],["","55111029336","SUMATRIPTAN ","100MG","9.00","Select","Select",""],["","00378064110","PREDNISONE ","10MG","20.00","Select","Select",""],["","51672137706","ADAPALENE ","0.30%","45.00","Select","Select",""],["","00378967130","IPRATROPIUM\/ ","ALBUTER","90.00","Select","Select",""],["","59762374401","CLINDAMYCIN ","10MG\/ML","60.00","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16.00","Select","Select",""],["","68462010530","ONDANSETRON ","4MG","10.00","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":""}]}]}