{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JETTSY E SIMPSON","gend":1,"add":"839 25TH","city":"NEWPORT NEWS","state":"VA","zip":"23607-9998","dob":"1942-06-24","age":"","mstatus":"","insh":"11008835","cliId":"","pno":7572473282,"cno":7579772255,"email":"","ename":"","eno":"","pphy":"LORENZO, DAVID","ppno":7575910643,"pcpadd":"4714 Marshall Ave","pcpcity":"Newport News","pcpstate":"VA","pcpzip":236072247,"pcpcounty":"","pcpid":"","pcpname":"PENINSULA INSTITUTE FOR COMMUNITY HEALTH INC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"839 25TH","madd2":"","madd3":"","mcity":"NEWPORT NEWS","mstate":"VA","mzip":"23607-9998","pcpfaxno":"(757) 952-1345","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":[["","55111015901","OMEPRAZOLE ","40MG","90.00","Select","Select",""],["","50742062201","NIFEDIPINE ","90MG ER","90.00","Select","Select",""],["","69097081307","GABAPENTIN ","100MG","90.00","Select","Select",""],["","60432026415","FLUTICASONE ","50MCG","16.00","Select","Select",""],["","54092060601","XIIDRA ","5%","180.00","Select","Select",""],["","61314054701","LATANOPROST ","0.01%","5.00","Select","Select",""],["","00093310953","AMOXICILLIN ","500MG","30.00","Select","Select",""],["","16714007104","BACLOFEN ","10MG","60.00","Select","Select",""],["","65162003310","APAP\/CODEINE ","300-30MG","12.00","Select","Select",""],["","58160084252","BOOSTRIX ","","0.50","Select","Select",""],["","70461012003","FLUAD ","0.5ML","0.50","Select","Select",""],["","49281012165","FLUZONE ","2021-22","0.70","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":""}]}]}