{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RONDA K MASON","gend":1,"add":"112 S KENT STREET","city":"WINCHESTER","state":"VA","zip":"22601-9998","dob":"1979-07-29","age":"","mstatus":"","insh":"11014387","cliId":"","pno":5402774799,"cno":"","email":"","ename":"","eno":"","pphy":"MILLER, STACY MICHELLE","ppno":7034432000,"pcpadd":"525 Amherst St Ste 104","pcpcity":"Winchester","pcpstate":"VA","pcpzip":226013881,"pcpcounty":"","pcpid":"","pcpname":"WINCHESTER FAMILY HEALTH CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"315 N KENT STREET","madd2":"","madd3":"","mcity":"WINCHESTER","mstate":"VA","mzip":"22601-9998","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":[["","70700015010","OMEPRAZOLE ","20MG","90.00","Select","Select",""],["","69238111701","BUSPIRONE ","10MG","30.00","Select","Select",""],["","68382080601","TRAZODONE ","100MG","90.00","Select","Select",""],["","00310737020","BUDES\/FORMOT ","160-4.5","10.20","Select","Select",""],["","00093317431","ALBUTEROL ","E","8.50","Select","Select",""],["","65862020290","LOSARTAN ","50MG","30.00","Select","Select",""],["","00378395105","ATORVASTATIN ","20MG","90.00","Select","Select",""],["","00228282011","HYDROCHLOROT ","12.5MG","90.00","Select","Select",""],["","57894064011","TREMFYA ","100MG\/ML","1.00","Select","Select",""],["","00074204202","SKYRIZI ","150DOSE","1.00","Select","Select",""],["","68180051902","LISINOP\/HCTZ ","20-12.5","30.00","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0.50","Select","Select",""],["","51672127401","BETAMETH ","0.05%","15.00","Select","Select",""],["","00378064205","PREDNISONE ","20MG","10.00","Select","Select",""],["","00074055402","HUMIRA ","40\/0.4ML","2.00","Select","Select",""],["","00186037020","SYMBICORT ","160-4.5","10.20","Select","Select",""],["","58160084252","BOOSTRIX ","","0.50","Select","Select",""],["","00006412102","GARDASIL ","","0.50","Select","Select",""],["","00781808926","AZITHROMYCIN ","250MG","6.00","Select","Select",""],["","68180065208","DOXYCYC ","100MG","20.00","Select","Select",""],["","00093310905","AMOXICILLIN ","500MG","30.00","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":""}]}]}