{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JEFFREY R CREW","gend":0,"add":"13508 EVELYN DR","city":"CHESTER","state":"VA","zip":"23831-9998","dob":"1991-08-01","age":"","mstatus":"","insh":"11015197","cliId":"","pno":8047965846,"cno":"","email":"","ename":"","eno":"","pphy":"LINGLER, KIMBERLY","ppno":8047489071,"pcpadd":"12801 IRON BRIDGE ROAD SUITE 100","pcpcity":"CHESTER","pcpstate":"VA","pcpzip":238310000,"pcpcounty":"","pcpid":"","pcpname":"SOUTHSIDE PHYSICIAN NETWORK LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"APT 2","add3":"","madd1":"13508 EVELYN DR","madd2":"APT 2","madd3":"","mcity":"CHESTER","mstate":"VA","mzip":"23831-9998","pcpfaxno":"(804) 768-8626","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":[["","65862019401","FLUOXETINE ","40MG","30.00","Select","Select",""],["","27241005103","ARIPIPRAZOLE ","2MG","30.00","Select","Select",""],["","00093506001","HYDROXYZ ","10MG","60.00","Select","Select",""],["","68180051201","LISINOPRIL ","2.5MG","90.00","Select","Select",""],["","00002143380","TRULICITY ","0.75\/0.5","2.00","Select","Select",""],["","67877041305","METFORMIN ","500MG ER","120.00","Select","Select",""],["","08290320122","BD  PEN NEEDL","32GX4MM","100.00","Select","Select",""],["","68180046409","SIMVASTATIN ","40MG","90.00","Select","Select",""],["","00088221905","LANTUS ","100\/ML","15.00","Select","Select",""],["","00193731221","CONTOUR ","NEXT","200.00","Select","Select",""],["","00002771559","BASAGLAR ","100UNIT","9.00","Select","Select",""],["","00310654004","BYDUREON ","2\/0.85ML","3.40","Select","Select",""],["","00002822259","INSULIN ","100\/ML","15.00","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":["",""],"sub":{"indx":[["","",""],[""],[""],[""],[""]],"comment":[["","",""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}