{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DEBORAH SAYLES","gend":1,"add":"100 PRINCESS ANNE STREET, APARTMENT 409","city":"FREDERICKSBURG","state":"VA","zip":"22401-9998","dob":"1963-01-25","age":"","mstatus":"","insh":"11010047","cliId":"","pno":5404796456,"cno":"","email":"","ename":"","eno":"","pphy":"ALEXANDER, DAWN","ppno":5407109100,"pcpadd":"231 Garrisonville Rd Ste 101","pcpcity":"Stafford","pcpstate":"VA","pcpzip":225541604,"pcpcounty":"","pcpid":"","pcpname":"RAPPAHANNOCK FAMILY PHYSICIANS","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"100 PRINCESS ANNE STREET, APARTMENT 409","madd2":"","madd3":"","mcity":"FREDERICKSBURG","mstate":"VA","mzip":"22401-9998","pcpfaxno":"(540) 373-0942","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":[["","67877041401","METFORMIN ","750MG ER","30.00","Select","Select",""],["","53489011905","DOXYCYCL ","100MG","10.00","Select","Select",""],["","00093317431","ALBUTEROL ","E","8.50","Select","Select",""],["","00378064110","PREDNISONE ","10MG","63.00","Select","Select",""],["","65162083366","DICLOFENAC ","1%","300.00","Select","Select",""],["","53746054201","POT  CHLORIDE","10MEQ ER","180.00","Select","Select",""],["","00310737020","BUDES\/FORMOT ","160-4.5","30.60","Select","Select",""],["","53885001110","ONETOUCH ","PLUS 30G","100.00","Select","Select",""],["","65862057490","MONTELUKAST ","10MG","90.00","Select","Select",""],["","00093414856","LEVALBUTEROL ","1.25MG","540.00","Select","Select",""],["","68180016006","AZITHROMYCIN ","250MG","12.00","Select","Select",""],["","00378967130","IPRATROPIUM\/ ","ALBUTER","180.00","Select","Select",""],["","69097094312","GABAPENTIN ","300MG","270.00","Select","Select",""],["","00597010061","SPIRIVA ","2.5MCG","12.00","Select","Select",""],["","00378247401","DICLOFEN ","50MG","90.00","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","48.00","Select","Select",""],["","70377000215","SIMVASTATIN ","10MG","90.00","Select","Select",""],["","57664050658","METOPROL ","25MG","180.00","Select","Select",""],["","00378020810","FUROSEMIDE ","20MG","270.00","Select","Select",""],["","59651000305","OMEPRAZOLE ","40MG","180.00","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","30.00","Select","Select",""],["","65862053750","LEVOFLOXACIN ","500MG","5.00","Select","Select",""],["","55513071001","PROLIA ","60MG\/ML","1.00","Select","Select",""],["","10702001801","OXYCODONE ","5MG","20.00","Select","Select",""],["","00832054111","BUMETANIDE ","1MG","180.00","Select","Select",""],["","00173087310","INCRUSE ","62.5MCG","30.00","Select","Select",""],["","65862085901","FAMOTIDINE ","20MG","180.00","Select","Select",""],["","00093770198","LEVOCETIRIZI ","5MG","90.00","Select","Select",""],["","00054414622","CLOTRIMAZOLE ","10MG","70.00","Select","Select",""],["","71093014005","METHOCARBAM ","500MG","30.00","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":""}]}]}