{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JASMINE V GARY","gend":1,"add":"C\/O EVELYN WHITFIELD","city":"SUFFOLK","state":"VA","zip":"23437-9998","dob":"1991-01-12","age":"","mstatus":"","insh":"11012636","cliId":"","pno":7579106889,"cno":"","email":"","ename":"","eno":"","pphy":"PONDER, JAMES MICHAEL","ppno":7576532007,"pcpadd":"102 Fairview Dr Ste B","pcpcity":"Franklin","pcpstate":"VA","pcpzip":238511206,"pcpcounty":"","pcpid":"","pcpname":"FRANKLIN CLINIC CORPORATION","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"6116 HOLY NECK ROAD","add3":"","madd1":"C\/O EVELYN WHITFIELD","madd2":"6116 HOLY NECK ROAD","madd3":"","mcity":"SUFFOLK","mstate":"VA","mzip":"23437-9998","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":[["","60505082901","FLUTICASONE ","50MCG","16.00","Select","Select",""],["","16729017317","AMITRIPTYLIN ","50MG","30.00","Select","Select",""],["","50742023301","ACETAZOLAMID ","500MG ER","60.00","Select","Select",""],["","00378668977","PANTOPRAZOLE ","40MG","30.00","Select","Select",""],["","00093506105","HYDROXYZ ","25MG","60.00","Select","Select",""],["","59762305102","AZITHROMYCIN ","1GM PAK","1.00","Select","Select",""],["","65862086001","FAMOTIDINE ","40MG","90.00","Select","Select",""],["","53489012002","DOXYCYCL ","100MG","14.00","Select","Select",""],["","62175011843","OMEPRAZOLE ","20MG","90.00","Select","Select",""],["","00093317431","ALBUTEROL ","E","8.50","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","14.00","Select","Select",""],["","00093031401","KETOROLAC ","10MG","15.00","Select","Select",""],["","00781320685","CEFTRIAXONE ","250MG","1.00","Select","Select",""],["","68462010530","ONDANSETRON ","4MG","12.00","Select","Select",""],["","65862078430","ESOMEPRA ","40MG DR","90.00","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":""}]}]}