{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOHN C ELSEY","gend":0,"add":"12472 CRICKET LANE","city":"WOODBRIDGE","state":"VA","zip":"22192-9998","dob":"1973-08-27","age":"","mstatus":"","insh":"11011542","cliId":"","pno":5712649954,"cno":5713439483,"email":"","ename":"","eno":"","pphy":"BOMMASANI, REENA R","ppno":7037302000,"pcpadd":"13168 Centerpointe Way Ste 101","pcpcity":"Woodbridge","pcpstate":"VA","pcpzip":221935287,"pcpcounty":"","pcpid":"","pcpname":"MILLENIUM MEDICAL CORPORATION","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"12472 CRICKET LANE","madd2":"","madd3":"","mcity":"WOODBRIDGE","mstate":"VA","mzip":"22192-9998","pcpfaxno":"(703) 730-6767","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":[["","00228202750","ALPRAZOLAM ","0.25MG","30.00","Select","Select",""],["","00378181710","LEVOTHYROXIN ","175MCG","90.00","Select","Select",""],["","50742061510","METOPROL ","25MG ER","30.00","Select","Select",""],["","53746054201","POT  CHLORIDE","10MEQ ER","90.00","Select","Select",""],["","70377000911","ROSUVASTATIN ","40MG","90.00","Select","Select",""],["","16729020001","BUSPIRONE ","5MG","90.00","Select","Select",""],["","00173071920","FLOVENT ","110MCG","36.00","Select","Select",""],["","68382065005","ISOSORB ","30MG ER","90.00","Select","Select",""],["","00378020810","FUROSEMIDE ","20MG","270.00","Select","Select",""],["","70710134403","RAMELTEON ","8MG","30.00","Select","Select",""],["","51862024030","AMIODARONE ","100MG","180.00","Select","Select",""],["","65862008601","BISOPROL ","5MG","90.00","Select","Select",""],["","53746051101","SPIRONOLACT ","25MG","90.00","Select","Select",""],["","00078065920","ENTRESTO ","24-26MG","180.00","Select","Select",""],["","00781185220","AMOX\/K ","875-125","20.00","Select","Select",""],["","50111091801","TORSEMIDE ","100MG","90.00","Select","Select",""],["","59310057922","PROAIR ","","8.50","Select","Select",""],["","50458057830","XARELTO ","15MG","30.00","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21.00","Select","Select",""],["","00254100752","ALBUTEROL ","HFA","13.40","Select","Select",""],["","13668000705","ZOLPIDEM ","5MG","30.00","Select","Select",""],["","53489011905","DOXYCYCL ","100MG","14.00","Select","Select",""],["","00832054111","BUMETANIDE ","1MG","270.00","Select","Select",""],["","55111072901","ALLOPURINOL ","100MG","45.00","Select","Select",""],["","76385011250","CARVEDILOL ","12.5MG","180.00","Select","Select",""],["","00254200801","COLCHICINE ","0.6MG","90.00","Select","Select",""],["","65862035790","CLOPIDOGREL ","75MG","90.00","Select","Select",""],["","00597015230","JARDIANCE ","10MG","90.00","Select","Select",""],["","49281042010","FLUZONE ","2020-21","0.50","Select","Select",""],["","43598043611","NITROGLYCERN ","0.4MG","75.00","Select","Select",""],["","00093101042","MUPIROCIN ","2%","22.00","Select","Select",""],["","68180016013","AZITHROMYCIN ","250MG","6.00","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":["",""],"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":""}]}]}