{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JULIE R CARACOFE","gend":1,"add":"9163 N CONGRESS STREET","city":"NEW MARKET","state":"VA","zip":"22844-9414","dob":"1963-01-17","age":"","mstatus":"","insh":"11010232","cliId":"","pno":5405787773,"cno":5403601832,"email":"","ename":"","eno":"","pphy":"HILL, JORDAN L","ppno":5409010800,"pcpadd":"173 E Springbrook Rd","pcpcity":"Broadway","pcpstate":"VA","pcpzip":228159526,"pcpcounty":"","pcpid":"","pcpname":"SRMH TIMBER WAY HEALTH CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"APT I","add3":"","madd1":"9163 N CONGRESS STREET","madd2":"APT I","madd3":"","mcity":"NEW MARKET","mstate":"VA","mzip":"22844-9414","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":[["","53885027210","ONETOUCH ","VERIO","100.00","Select","Select",""],["","73070010315","INSULIN ","FLEXPEN","9.00","Select","Select",""],["","00169406013","VICTOZA ","18MG\/3ML","9.00","Select","Select",""],["","67877056305","METFORMIN ","1000MG","60.00","Select","Select",""],["","68462039710","OMEPRAZOLE ","40MG","90.00","Select","Select",""],["","69097094312","GABAPENTIN ","300MG","30.00","Select","Select",""],["","00169255013","TRESIBA ","200UNIT","9.00","Select","Select",""],["","57237007530","ONDANSETRON ","4MG","15.00","Select","Select",""],["","57599080300","FREESTY ","2 READER","1.00","Select","Select",""],["","65862056090","PANTOPRAZOLE ","40MG","30.00","Select","Select",""],["","69238183407","LEVOTHYROXIN ","100MCG","30.00","Select","Select",""],["","43547043109","FENOFIBRATE ","145MG","30.00","Select","Select",""],["","69238115403","EZETIMIBE ","10MG","90.00","Select","Select",""],["","00378395305","ATORVASTATIN ","80MG","90.00","Select","Select",""],["","65862029630","ROSUVASTATIN ","40MG","90.00","Select","Select",""],["","00597015330","JARDIANCE ","25MG","30.00","Select","Select",""],["","10631020602","RIOMET ","","300.00","Select","Select",""],["","52817031910","BACLOFEN ","5MG","30.00","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","10.00","Select","Select",""],["","52817033010","CYCLOBENZAPR ","5MG","90.00","Select","Select",""],["","59762516003","SERTRALINE ","100MG","135.00","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":["",""],"sub":{"indx":[["","",""],[""],[""],[""],[""]],"comment":[["","",""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}