{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMBER K RICE","gend":1,"add":"344 SUMMIT ST","city":"HARRISONBURG","state":"VA","zip":"22802-9998","dob":"1988-02-04","age":"","mstatus":"","insh":"11014916","cliId":"","pno":5404354172,"cno":"","email":"","ename":"","eno":"","pphy":"NIO, DEBORAH A","ppno":5404339151,"pcpadd":"1831 Reservoir St","pcpcity":"Harrisonburg","pcpstate":"VA","pcpzip":228018743,"pcpcounty":"","pcpid":"","pcpname":"HARRISONBURG FAMILY PRACTICE ASSOC PC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"344 SUMMIT ST","madd2":"","madd3":"","mcity":"HARRISONBURG","mstate":"VA","mzip":"22802-9998","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":[["","66993001968","ALBUTEROL ","HFA","18.00","Select","Select",""],["","13107004401","OXYCOD\/APAP ","5-325MG","10.00","Select","Select",""],["","00093083201","CLONAZEPAM ","0.5MG","10.00","Select","Select",""],["","62135030901","CIPROFLOXACN ","500MG","10.00","Select","Select",""],["","69097084507","CYCLOBENZAPR ","5MG","30.00","Select","Select",""],["","00713070185","MOMETASONE ","0.10%","30.00","Select","Select",""],["","00406055201","OXYCODONE ","5MG","5.00","Select","Select",""],["","00168005646","BETAMETH ","0.05%","45.00","Select","Select",""],["","16729017317","AMITRIPTYLIN ","50MG","120.00","Select","Select",""],["","00143924920","AMOX\/K ","875-125","14.00","Select","Select",""],["","69547035302","NARCAN ","","2.00","Select","Select",""],["","00054001925","PREDNISONE ","50MG","8.00","Select","Select",""],["","59310057922","PROAIR ","","8.50","Select","Select",""],["","65162037210","OXYBUTYNIN ","10MG ER","30.00","Select","Select",""],["","67877021905","CEPHALEXIN ","500MG","21.00","Select","Select",""],["","68382004101","PROMETHAZINE ","25MG","10.00","Select","Select",""],["","42571013252","CROMOLYN ","100\/5ML","960.00","Select","Select",""],["","68462049833","ZOLMITRIPTAN ","5MG","10.00","Select","Select",""],["","68382013201","TAMSULOSIN ","0.4MG","30.00","Select","Select",""],["","57237007710","ONDANSETRON ","4MG ODT","30.00","Select","Select",""],["","67877022310","GABAPENTIN ","300MG","90.00","Select","Select",""],["","00006003330","BELSOMRA ","10MG","30.00","Select","Select",""],["","57237001830","DULOXETINE ","30MG","30.00","Select","Select",""],["","29033000305","SUCRALFATE ","1GM","120.00","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":""}]}]}