{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SALLY R ROBERTSON","gend":1,"add":"207 HUGHES ST","city":"DANVILLE","state":"VA","zip":"24541-9998","dob":"1938-09-29","age":"","mstatus":"","insh":"11010221","cliId":"","pno":4342287202,"cno":"","email":"","ename":"","eno":"","pphy":"LAHURD JR, NEIL J","ppno":4344461070,"pcpadd":"949 PINEY FOREST RD","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":245401591,"pcpcounty":"","pcpid":"","pcpname":"GODOCS","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"N","ano":"","add2":"","add3":"","madd1":"207 HUGHES ST","madd2":"","madd3":"","mcity":"DANVILLE","mstate":"VA","mzip":"24541-9998","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":[["","69543013611","TRAMADOL ","50MG","14.00","Select","Select",""],["","68462026290","ROSUVASTATIN ","10MG","90.00","Select","Select",""],["","69097012815","AMLODIPINE ","10MG","30.00","Select","Select",""],["","00591219101","RAMELTEON ","8MG","30.00","Select","Select",""],["","59385002260","BELBUCA ","150MCG","60.00","Select","Select",""],["","16729018317","HYDROCHLOROT ","25MG","90.00","Select","Select",""],["","67877022210","GABAPENTIN ","100MG","90.00","Select","Select",""],["","65862085999","FAMOTIDINE ","20MG","60.00","Select","Select",""],["","00093365740","BUPRENORPHIN ","10MCG\/HR","4.00","Select","Select",""],["","65862020299","LOSARTAN ","50MG","90.00","Select","Select",""],["","68462015713","ONDANSETRON ","4MG ODT","30.00","Select","Select",""],["","00378668977","PANTOPRAZOLE ","40MG","60.00","Select","Select",""],["","43598051030","ESOMEPRA ","40MG DR","60.00","Select","Select",""],["","53746010905","HYDROCO\/APAP ","5-325MG","10.00","Select","Select",""],["","60505258008","ATORVASTATIN ","40MG","90.00","Select","Select",""],["","61314062810","POLYMYXIN ","TRIMETHP","10.00","Select","Select",""],["","00591078001","SUCRALFATE ","1GM","120.00","Select","Select",""],["","00527600274","LIDOCAINE ","2% VISC","150.00","Select","Select",""],["","65862001501","AMOXICILLIN ","875MG","10.00","Select","Select",""],["","00093220401","METOCLOPRAM ","5MG","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":["",""]}},{"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":""}]}]}