{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAMES CLARKSON","gend":0,"add":"492 MOUNTAIN PROSPECT LN","city":"CULPEPER","state":"VA","zip":"22701-9998","dob":"1955-03-29","age":"","mstatus":"","insh":"11014349","cliId":"","pno":5402290757,"cno":"","email":"","ename":"","eno":"","pphy":"BABAR, AHMAD","ppno":7037069897,"pcpadd":"4376 Germanna Hwy","pcpcity":"Locust Grove","pcpstate":"VA","pcpzip":225082008,"pcpcounty":"","pcpid":"","pcpname":"UVA PRIMARY CARE COMMONWEALTH MEDICAL","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"492 MOUNTAIN PROSPECT LN","madd2":"","madd3":"","mcity":"CATALPA","mstate":"VA","mzip":"22701-9998","pcpfaxno":"(540) 972-3536","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":[["","43547040111","FUROSEMIDE ","20MG","30.00","Select","Select",""],["","00121087316","LACTULOSE ","10GM\/15","946.00","Select","Select",""],["","16714008401","SPIRONOLACT ","25MG","90.00","Select","Select",""],["","62332000131","FAMOTIDINE ","20MG","90.00","Select","Select",""],["","43547035311","LISINOPRIL ","10MG","90.00","Select","Select",""],["","69547035302","NARCAN ","","2.00","Select","Select",""],["","59746011306","PROCHLORPER ","5MG","30.00","Select","Select",""],["","10702001801","OXYCODONE ","5MG","20.00","Select","Select",""],["","68180012201","CEPHALEXIN ","500MG","10.00","Select","Select",""],["","72626270101","SOFOS\/VELPAT ","400-100","28.00","Select","Select",""],["","68462016201","CARVEDILOL ","3.125MG","60.00","Select","Select",""],["","55111011230","MOXIFLOXACIN ","400MG","4.00","Select","Select",""],["","29033000301","SUCRALFATE ","1GM","30.00","Select","Select",""],["","62332001731","METRONIDAZOL ","500MG","15.00","Select","Select",""],["","53746066901","ACEBUTOLOL ","200MG","45.00","Select","Select",""],["","00591555401","PROPRANOLOL ","10MG","60.00","Select","Select",""],["","00781261305","AMOXICILLIN ","500MG","21.00","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":""}]}]}