{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANN R CHIPPS","gend":1,"add":"2406 Pittston Rd","city":"Fredericksburg","state":"VA","zip":"22408-0282","dob":"1985-02-02","age":"","mstatus":"","insh":"11012575","cliId":"","pno":4347096220,"cno":4346888585,"email":"","ename":"","eno":"","pphy":"LAHURD JR, NEIL J","ppno":4344461070,"pcpadd":"949 PINEY FOREST RD","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":245401591,"pcpcounty":"","pcpid":"","pcpname":"GODOCS","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"2406 Pittston Rd","madd2":"","madd3":"","mcity":"Fredericksburg","mstate":"VA","mzip":"22408-0282","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":[["","23155010205","METFORMIN ","500MG","60.00","Select","Select",""],["","68382003616","VENLAFAXINE ","150MG ER","90.00","Select","Select",""],["","68180051703","LISINOPRIL ","40MG","90.00","Select","Select",""],["","16714035502","LEVETIRACETA ","500MG","180.00","Select","Select",""],["","68180071909","AMLODIPINE ","2.5MG","90.00","Select","Select",""],["","00131248035","VIMPAT ","200MG","60.00","Select","Select",""],["","59310057922","PROAIR ","","8.50","Select","Select",""],["","00173085910","BREO ","100-25","60.00","Select","Select",""],["","65862057490","MONTELUKAST ","10MG","30.00","Select","Select",""],["","16714087603","ATORVASTATIN ","40MG","30.00","Select","Select",""],["","16729018217","HYDROCHLOROT ","12.5MG","30.00","Select","Select",""],["","64764017130","DEXILANT ","30MG DR","30.00","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18.00","Select","Select",""],["","51672400501","CARBAMAZEPIN ","200MG","240.00","Select","Select",""],["","13811071910","NITROFURANTN ","100MG","2.00","Select","Select",""],["","69238130601","CLOBAZAM ","20MG","60.00","Select","Select",""],["","51991029301","OXCARBAZEPIN ","300MG","60.00","Select","Select",""],["","43547034250","RISPERIDONE ","2MG","180.00","Select","Select",""],["","68462013001","ZONISAMIDE ","100MG","60.00","Select","Select",""],["","00173068220","VENTOLIN ","","18.00","Select","Select",""],["","65862018730","ONDANSETRON ","4MG","9.00","Select","Select",""],["","62756079813","DIVALPROEX ","500MG DR","60.00","Select","Select",""],["","55111028130","LEVOFLOXACIN ","750MG","5.00","Select","Select",""],["","53746051101","SPIRONOLACT ","25MG","90.00","Select","Select",""],["","00603533715","PREDNISONE ","5MG","21.00","Select","Select",""],["","00143211205","DOXYCYCL ","100MG","20.00","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}