{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SANTOS A CANALES","gend":1,"add":"2021 CHERRI DR","city":"FALLS CHURCH","state":"VA","zip":"22043-9998","dob":"1959-06-02","age":"","mstatus":"","insh":"11013756","cliId":"","pno":7032016204,"cno":"","email":"","ename":"","eno":"","pphy":"FLOY, TINA","ppno":7033567882,"pcpadd":"8294 Old Courthouse Rd Ste A","pcpcity":"Vienna","pcpstate":"VA","pcpzip":221823871,"pcpcounty":"","pcpid":"","pcpname":"WELLNESS PEDIATRICS PC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"2021 CHERRI DR","madd2":"","madd3":"","mcity":"FALLS CHURCH","mstate":"VA","mzip":"22043-9998","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":[["","55111012205","ATORVASTATIN ","20MG","90.00","Select","Select",""],["","00378718505","METFORMIN ","500MG","180.00","Select","Select",""],["","08484072500","PRODIGY ","CODING","200.00","Select","Select",""],["","68462016405","CARVEDILOL ","12.5MG","180.00","Select","Select",""],["","68180072103","AMLODIPINE ","10MG","10.00","Select","Select",""],["","00527133001","BACLOFEN ","10MG","270.00","Select","Select",""],["","59762054201","GLIPIZIDE ","10MG","180.00","Select","Select",""],["","71930006415","LEVETIRACETA ","750MG","180.00","Select","Select",""],["","69097052444","DICLOFENAC ","1%","500.00","Select","Select",""],["","08290320550","BD  PEN NEEDL","32GX5\/32","100.00","Select","Select",""],["","65162010250","GABAPENTIN ","300MG","270.00","Select","Select",""],["","65162062711","TRAMADOL ","50MG","45.00","Select","Select",""],["","00002223680","TRULICITY ","3\/0.5","2.00","Select","Select",""],["","00169643810","LEVEMIR ","FLEXTOUC","3.00","Select","Select",""],["","31722052101","HYDRALAZINE ","50MG","270.00","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","14.00","Select","Select",""],["","59746033890","LOSARTAN\/HCT ","100-12.5","90.00","Select","Select",""],["","65862018601","CLINDAMYCIN ","300MG","28.00","Select","Select",""],["","65862001705","AMOXICILLIN ","500MG","21.00","Select","Select",""],["","64380080807","IBUPROFEN ","600MG","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}