{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TRACY L HUTCHINGS","gend":1,"add":"1086 GOLDEN LEAF RD","city":"NATHALIE","state":"VA","zip":"24577-9998","dob":"1968-03-14","age":"","mstatus":"","insh":"11013105","cliId":"","pno":4344712421,"cno":"","email":"","ename":"","eno":"","pphy":"ADJEI, FRANK","ppno":4344393313,"pcpadd":"15210 L P Bailey Memorial Hwy","pcpcity":"Nathalie","pcpstate":"VA","pcpzip":245773304,"pcpcounty":"","pcpid":"","pcpname":"VOLENS FAMILY PRACTICE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1086 GOLDEN LEAF RD","madd2":"","madd3":"","mcity":"NATHALIE","mstate":"VA","mzip":"24577-9998","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":[["","49483060350","IBUPROFEN ","600MG","30.00","Select","Select",""],["","53746010901","HYDROCO\/APAP ","5-325MG","90.00","Select","Select",""],["","00121067516","VALPROIC ","250\/5ML","450.00","Select","Select",""],["","57664050658","METOPROL ","25MG","30.00","Select","Select",""],["","65862001205","SERTRALINE ","50MG","90.00","Select","Select",""],["","57237004705","DIVALPROEX ","250MG DR","150.00","Select","Select",""],["","10702025350","BUT\/APAP\/CAF ","","30.00","Select","Select",""],["","65862050320","AMOX\/K ","875-125","20.00","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","6.00","Select","Select",""],["","70377000315","SIMVASTATIN ","20MG","90.00","Select","Select",""],["","00131541072","VIMPAT ","10MG\/ML","800.00","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","28.00","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","473.00","Select","Select",""],["","69097012503","TOPIRAMATE ","200MG","180.00","Select","Select",""],["","00093220401","METOCLOPRAM ","5MG","20.00","Select","Select",""],["","33332032001","AFLURIA ","2020-21","0.50","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":""}]}]}