{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRADLEY GARY","gend":0,"add":"417 SEABURY AVENUE","city":"SANDSTON","state":"VA","zip":"23150-2213","dob":"1970-08-16","age":"","mstatus":"","insh":"11015735","cliId":"","pno":8047799702,"cno":"","email":"","ename":"","eno":"","pphy":"ANSARI, NATHER B","ppno":5407859900,"pcpadd":"1075 GARRISONVILLE RDSte 115","pcpcity":"STAFFORD","pcpstate":"VA","pcpzip":225568600,"pcpcounty":"","pcpid":"","pcpname":"PRIMARY AND URGENT CARE LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"417 SEABURY AVENUE","madd2":"","madd3":"","mcity":"SANDSTON","mstate":"VA","mzip":"23150-2213","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":[["","53885024510","ONETOUCH ","ULTRA","100.00","Select","Select",""],["","00378668999","PANTOPRAZOLE ","40MG","180.00","Select","Select",""],["","67877056105","METFORMIN ","500MG","60.00","Select","Select",""],["","60505014102","GLIPIZIDE ","5MG","60.00","Select","Select",""],["","00003089421","ELIQUIS ","5MG","60.00","Select","Select",""],["","27241009903","DULOXETINE ","60MG","180.00","Select","Select",""],["","69097068105","PREGABALIN ","100MG","60.00","Select","Select",""],["","00527133001","BACLOFEN ","10MG","45.00","Select","Select",""],["","00088221905","LANTUS ","100\/ML","18.00","Select","Select",""],["","65162062711","TRAMADOL ","50MG","14.00","Select","Select",""],["","43547028910","BUPROPION ","150MG SR","60.00","Select","Select",""],["","67877043003","ARIPIPRAZOLE ","2MG","30.00","Select","Select",""],["","65862007930","TERBINAFINE ","250MG","90.00","Select","Select",""],["","08290320109","BD  PEN NEEDL","31GX8MM","100.00","Select","Select",""],["","68382091634","METHYLPRED ","4MG","21.00","Select","Select",""],["","68180098103","LISINOPRIL ","20MG","90.00","Select","Select",""],["","55111012305","ATORVASTATIN ","40MG","90.00","Select","Select",""],["","00591024105","LORAZEPAM ","1MG","2.00","Select","Select",""],["","00093220401","METOCLOPRAM ","5MG","7.00","Select","Select",""],["","51672130104","AMMONIUM ","12%","280.00","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":""}]}]}