{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOHN C WADE","gend":0,"add":"709 LANSBURY DRIVE","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"1952-12-05","age":"","mstatus":"","insh":"11009176","cliId":"","pno":4344299691,"cno":"","email":"","ename":"","eno":"","pphy":"ADDIS, DANIEL M","ppno":4347917366,"pcpadd":"219 Parker Rd","pcpcity":"Danville","pcpstate":"VA","pcpzip":245404034,"pcpcounty":"","pcpid":"","pcpname":"PIEDMONT FAMILY AND OCCUPATIONAL MEDICINE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"709 LANSBURY DRIVE","madd2":"","madd3":"","mcity":"DANVILLE","mstate":"VA","mzip":"24540-9998","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":[["","65862002560","LAMIVUDINE ","150MG","30.00","Select","Select",""],["","31722055760","ABACAVIR ","300MG","60.00","Select","Select",""],["","49702022813","TIVICAY ","50MG","30.00","Select","Select",""],["","00781713593","MOXIFLOXACIN ","HCL 0.5%","3.00","Select","Select",""],["","29300012410","MELOXICAM ","7.5MG","20.00","Select","Select",""],["","52817033200","CYCLOBENZAPR ","10MG","10.00","Select","Select",""],["","61314012605","KETOROLAC ","0.50%","5.00","Select","Select",""],["","55111018015","TIZANIDINE ","4MG","30.00","Select","Select",""],["","00074262528","MAVYRET ","100-40MG","84.00","Select","Select",""],["","16729013401","ALLOPURINOL ","100MG","90.00","Select","Select",""],["","00781808926","AZITHROMYCIN ","250MG","6.00","Select","Select",""],["","69238161503","OFLOXACIN ","0.3%OTIC","5.00","Select","Select",""],["","61314063705","PREDNISOLONE ","1% OP","5.00","Select","Select",""],["","00378108601","COLCHICINE ","0.6MG","15.00","Select","Select",""],["","23155013525","DOXYCYC ","100MG","28.00","Select","Select",""],["","00093101042","MUPIROCIN ","2%","22.00","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":""}]}]}