{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JEFFREY S MONGER","gend":0,"add":"1530 NEWTOWN RD","city":"ELKTON","state":"VA","zip":"22827-9998","dob":"1968-03-08","age":"","mstatus":"","insh":"11011186","cliId":"","pno":5405605887,"cno":"","email":"","ename":"","eno":"","pphy":"FOWLER, ROCKY W","ppno":5405645622,"pcpadd":"1790 E Market St Ste 64B","pcpcity":"Harrisonburg","pcpstate":"VA","pcpzip":228015197,"pcpcounty":"","pcpid":"","pcpname":"EAST ROCKINGHAM HEALTH CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1530 NEWTOWN RD","madd2":"","madd3":"","mcity":"ELKTON","mstate":"VA","mzip":"22827-9998","pcpfaxno":"(844) 501-7984","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":[["","70010049105","METFORMIN ","ORAL TAB","360.00","Select","Select",""],["","68001041103","GABAPENTIN ","600MG","90.00","Select","Select",""],["","53885001110","ONETOUCH ","PLUS 30G","200.00","Select","Select",""],["","00406012505","HYDROCO\/APAP ","10-325MG","120.00","Select","Select",""],["","42571025201","CLINDAMYCIN ","300MG","28.00","Select","Select",""],["","08470354001","UNFINE ","32GX4MM","150.00","Select","Select",""],["","00002143480","TRULICITY ","1.5\/0.5","2.00","Select","Select",""],["","27808015701","ROSUVASTATIN ","20MG","30.00","Select","Select",""],["","50742061505","METOPROL ","25MG ER","15.00","Select","Select",""],["","65862035790","CLOPIDOGREL ","75MG","30.00","Select","Select",""],["","00093317431","ALBUTEROL ","E","8.50","Select","Select",""],["","42571016242","AMOX\/K ","875-125","20.00","Select","Select",""],["","00003089421","ELIQUIS ","5MG","60.00","Select","Select",""],["","00169266015","TRESIBA ","100UNIT","30.00","Select","Select",""],["","00169633910","NOVOLOG ","FLEXPEN","15.00","Select","Select",""],["","68001041306","DULOXETINE ","20MG","30.00","Select","Select",""],["","00378306605","FENOFIBRATE ","145MG","90.00","Select","Select",""],["","64380076111","OMEGA-3-ACID ","1GM","120.00","Select","Select",""],["","65862001501","AMOXICILLIN ","875MG","14.00","Select","Select",""],["","59310057922","PROAIR ","","8.50","Select","Select",""],["","73070010315","INSULIN ","FLEXPEN","45.00","Select","Select",""],["","08290320119","BD  PEN NEEDL","31GX5MM","200.00","Select","Select",""],["","68180016013","AZITHROMYCIN ","250MG","6.00","Select","Select",""],["","47781049005","DOXYCYCL ","100MG","20.00","Select","Select",""],["","53885004401","ONE ","VERIO FL","1.00","Select","Select",""],["","00002803101","GLUCAGON ","1MG","1.00","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":""}]}]}