{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOHN P COX","gend":0,"add":"162 BUFFALO RIDGE ROAD","city":"AMHERST","state":"VA","zip":"24521-4027","dob":"1945-11-30","age":"","mstatus":"","insh":"11012785","cliId":"","pno":4349412765,"cno":"","email":"","ename":"","eno":"","pphy":"BALMORIA, SANDRA K","ppno":7578245676,"pcpadd":"5219 LANKFORD HIGHWAY","pcpcity":"NEW CHURCH","pcpstate":"VA","pcpzip":234153332,"pcpcounty":"","pcpid":"","pcpname":"CHINCOTEAGUE ISLAND COMMUNITY HEALTH CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"162 BUFFALO RIDGE ROAD","madd2":"","madd3":"","mcity":"AMHERST","mstate":"VA","mzip":"24521-4027","pcpfaxno":"(757) 824-5872","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":[["","49281042050","FLUZONE ","2020-21","0.50","Select","Select",""],["","70377000415","SIMVASTATIN ","40MG","90.00","Select","Select",""],["","43547034006","RISPERIDONE ","0.5MG","90.00","Select","Select",""],["","00093742698","MONTELUKAST ","10MG","90.00","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","48.00","Select","Select",""],["","55111032201","GLIMEPIRIDE ","4MG","180.00","Select","Select",""],["","53885059501","ONETOUCH ","30G","100.00","Select","Select",""],["","00006027731","JANUVIA ","100MG","90.00","Select","Select",""],["","65862020299","LOSARTAN ","50MG","90.00","Select","Select",""],["","10702001801","OXYCODONE ","5MG","50.00","Select","Select",""],["","52268001201","SUPREP ","PREP KIT","354.00","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":""}]}]}