{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GLORIA A SMITH","gend":1,"add":"8873 SPOTSWOOD TRAIL #206","city":"STANARDSVILLE","state":"VA","zip":"22973-9998","dob":"1955-03-20","age":"","mstatus":"","insh":"11014234","cliId":"","pno":6614411699,"cno":"","email":"","ename":"","eno":"","pphy":"BOSTIC, BROOKE A","ppno":4349852891,"pcpadd":"140 Stoneridge Dr S Ste 100","pcpcity":"Ruckersville","pcpstate":"VA","pcpzip":229683096,"pcpcounty":"","pcpid":"","pcpname":"GREENE FAMILY MEDICINE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"8873 SPOTSWOOD TRAIL #206","madd2":"","madd3":"","mcity":"STANARDSVILLE","mstate":"VA","mzip":"22973-9998","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":[["","65862035705","CLOPIDOGREL ","75MG","90.00","Select","Select",""],["","62559049001","DIPHEN\/ATROP ","2.5MG","120.00","Select","Select",""],["","00527128201","DICYCLOMINE ","20MG","120.00","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18.00","Select","Select",""],["","68180098103","LISINOPRIL ","20MG","90.00","Select","Select",""],["","68382080610","TRAZODONE ","100MG","90.00","Select","Select",""],["","43547028210","ESCITALOPRAM ","20MG","90.00","Select","Select",""],["","60505267108","ATORVASTATIN ","80MG","90.00","Select","Select",""],["","68462039610","OMEPRAZOLE ","20MG","90.00","Select","Select",""],["","58160084252","BOOSTRIX ","","0.50","Select","Select",""],["","00069047103","CHANTIX ","0.5& 1MG","53.00","Select","Select",""],["","59310057922","PROAIR ","","8.50","Select","Select",""],["","68180031902","BUPROPN ","150MG XL","90.00","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","1.00","Select","Select",""],["","66993058497","FLUTIC\/SALME ","100\/50","60.00","Select","Select",""],["","00406012505","HYDROCO\/APAP ","10-325MG","28.00","Select","Select",""],["","42571016242","AMOX\/K ","875-125","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":["",""]}},{"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":""}]}]}