{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RICHARD E NEBLETT JR","gend":0,"add":"136 OLD MANSION RD","city":"VICTORIA","state":"VA","zip":"23974-9998","dob":"1979-11-23","age":"","mstatus":"","insh":"11015319","cliId":"","pno":4343213296,"cno":"","email":"","ename":"","eno":"","pphy":"CABRERA, MARY E","ppno":4346965555,"pcpadd":"1418 6TH STREET","pcpcity":"VICTORIA","pcpstate":"VA","pcpzip":239740001,"pcpcounty":"","pcpid":"","pcpname":"CENTRA SOUTHSIDE PROFESSIONAL LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"PO BOX 152","madd2":"","madd3":"","mcity":"VICTORIA","mstate":"VA","mzip":"23974-9998","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":[["","10702001850","OXYCODONE ","5MG","42.00","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","6.00","Select","Select",""],["","68001024617","ONDANSETRON ","4MG ODT","18.00","Select","Select",""],["","68462019005","NAPROXEN ","500MG","14.00","Select","Select",""],["","68001018306","QUETIAPINE ","300MG","30.00","Select","Select",""],["","52817033200","CYCLOBENZAPR ","10MG","21.00","Select","Select",""],["","68001000501","METHYLPRED ","4MG","21.00","Select","Select",""],["","64380080706","IBUPROFEN ","800MG","30.00","Select","Select",""],["","68462039710","OMEPRAZOLE ","40MG","90.00","Select","Select",""],["","65162062711","TRAMADOL ","50MG","21.00","Select","Select",""],["","65162010250","GABAPENTIN ","300MG","140.00","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":""}]}]}