{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHAUN L SMITH","gend":0,"add":"818 HUSTON STREET","city":"CHASE CITY","state":"VA","zip":"23924-9998","dob":"1978-08-18","age":"","mstatus":"","insh":"11010598","cliId":"","pno":4347385927,"cno":"","email":"","ename":"","eno":"","pphy":"SUSLICK, RANDALL H","ppno":4343725141,"pcpadd":"115 College St","pcpcity":"Clarksville","pcpstate":"VA","pcpzip":239279125,"pcpcounty":"","pcpid":"","pcpname":"CHASE CITY FAMILY PRACTICE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"818 HUSTON STREET","madd2":"","madd3":"","mcity":"CHASE CITY","mstate":"VA","mzip":"23924-9998","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":[["","10702005601","OXYCODONE ","10MG","180.00","Select","Select",""],["","13668001005","CITALOPRAM ","20MG","30.00","Select","Select",""],["","00597016061","SPIRIVA ","1.25MCG","4.00","Select","Select",""],["","00173085910","BREO ","100-25","60.00","Select","Select",""],["","43598029490","PREGABALIN ","100MG","270.00","Select","Select",""],["","00093317431","ALBUTEROL ","E","8.50","Select","Select",""],["","00115132019","COLESEVELAM ","625MG","540.00","Select","Select",""],["","68180016013","AZITHROMYCIN ","250MG","6.00","Select","Select",""],["","57664047758","METOPROL ","50MG","90.00","Select","Select",""],["","16571020106","DICLOFENAC ","75MG DR","60.00","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","40.00","Select","Select",""],["","00378064110","PREDNISONE ","10MG","21.00","Select","Select",""],["","00093321992","KETOCONAZOLE ","2%","60.00","Select","Select",""],["","55111015810","OMEPRAZOLE ","20MG","60.00","Select","Select",""],["","70710101002","OSELTAMIVIR ","75MG","10.00","Select","Select",""],["","13107008405","LORAZEPAM ","1MG","60.00","Select","Select",""],["","70710160901","BACLOFEN ","5MG","15.00","Select","Select",""],["","45802036665","TESTOSTERONE ","1.62%","75.00","Select","Select",""],["","00093342210","CYCLOBENZAPR ","10MG","90.00","Select","Select",""],["","63304069301","CLINDAMYCIN ","300MG","28.00","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","28.00","Select","Select",""],["","69547035302","NARCAN ","","2.00","Select","Select",""],["","53746010901","HYDROCO\/APAP ","5-325MG","10.00","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":""}]}]}