{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DOROTHY C PITTMAN","gend":1,"add":"8863 CRISMOND LN","city":"SPOTSYLVANIA","state":"VA","zip":"22551-9998","dob":"1933-04-16","age":"","mstatus":"","insh":"11011343","cliId":"","pno":5408055424,"cno":"","email":"","ename":"","eno":"","pphy":"AHMAD, NAEEM","ppno":5403683700,"pcpadd":"4510 Plank RdSte 200","pcpcity":"Fredericksburg","pcpstate":"VA","pcpzip":224070138,"pcpcounty":"","pcpid":"","pcpname":"SENIOR AND ADULT CARE LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"8863 CRISMOND LN","madd2":"","madd3":"","mcity":"SPOTSYLVANIA","mstate":"VA","mzip":"22551-9998","pcpfaxno":"(540) 891-6240","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":[["","68180051703","LISINOPRIL ","40MG","90.00","Select","Select",""],["","76385011250","CARVEDILOL ","12.5MG","180.00","Select","Select",""],["","23155000810","HYDROCHLOROT ","25MG","90.00","Select","Select",""],["","62175061743","PANTOPRAZOLE ","40MG","90.00","Select","Select",""],["","00093720198","PRAVASTATIN ","20MG","90.00","Select","Select",""],["","60505056000","OFLOXACIN ","0.3% OP","5.00","Select","Select",""],["","60758011905","PREDNISOLONE ","1% OP","5.00","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","1.00","Select","Select",""],["","49281012065","FLUZONE ","PF 20-21","0.70","Select","Select",""],["","66689000802","NYSTATIN ","100000","480.00","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":""}]}]}