{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SCARLETT FORD","gend":1,"add":"5200 LEWIS ROAD","city":"SANDSTON","state":"VA","zip":"23150-1939","dob":"1971-05-15","age":"","mstatus":"","insh":"11014828","cliId":"","pno":8044050840,"cno":"","email":"","ename":"","eno":"","pphy":"GOKLI, ANUP J","ppno":8049324388,"pcpadd":"1850 Pocahontas Trl","pcpcity":"Quinton","pcpstate":"VA","pcpzip":231411657,"pcpcounty":"","pcpid":"","pcpname":"CHICKAHOMINY FAMILY PRACTICE.","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"N","ano":"","add2":"APARTMENT 86","add3":"","madd1":"5200 LEWIS ROAD","madd2":"APARTMENT 86","madd3":"","mcity":"SANDSTON","mstate":"VA","mzip":"23150-1939","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":[["","00078092361","KISQALI ","FEMARA","91.00","Select","Select",""],["","65862056090","PANTOPRAZOLE ","40MG","180.00","Select","Select",""],["","68462019005","NAPROXEN ","500MG","60.00","Select","Select",""],["","00713022515","TRIAMCINOLON ","0.10%","45.00","Select","Select",""],["","70710122801","AMITRIPTYLIN ","75MG","21.00","Select","Select",""],["","55111018015","TIZANIDINE ","4MG","60.00","Select","Select",""],["","65862001105","SERTRALINE ","25MG","30.00","Select","Select",""],["","00168005615","BETAMETH ","0.05%","45.00","Select","Select",""],["","65162010250","GABAPENTIN ","300MG","180.00","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","30.00","Select","Select",""],["","57237007810","ONDANSETRON ","8MG ODT","30.00","Select","Select",""],["","70954000520","OXYBUTYNIN ","5MG","90.00","Select","Select",""],["","62756052269","SUMATRIPTAN ","100MG","9.00","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","48.00","Select","Select",""],["","59310057922","PROAIR ","","8.50","Select","Select",""],["","00555097302","AMPHET\/DEXTR ","20MG","30.00","Select","Select",""],["","00093100301","BUSPIRONE ","15MG","60.00","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","10.00","Select","Select",""],["","65862052890","VENLAFAXINE ","75MG ER","30.00","Select","Select",""],["","51224002250","AZITHROMYCIN ","250MG","6.00","Select","Select",""],["","00228203150","ALPRAZOLAM ","1MG","90.00","Select","Select",""],["","59762040101","SUCRALFATE ","1GM","10.00","Select","Select",""],["","52268001201","SUPREP ","PREP KIT","354.00","Select","Select",""],["","00527133850","DOXYCYC ","100MG","20.00","Select","Select",""],["","00069024430","TOVIAZ ","8MG","30.00","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18.00","Select","Select",""],["","00143980305","DOXYCYCL ","100MG","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":["",""]}},{"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":""}]}]}