{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SARA C HARPER","gend":1,"add":"8016 CHERRY TREE DR","city":"FREDERICKSBURG","state":"VA","zip":"22407-9998","dob":"1964-05-21","age":"","mstatus":"","insh":"11015742","cliId":"","pno":5408916359,"cno":"","email":"","ename":"","eno":"","pphy":"AMEEN, RICHARD J","ppno":5407869771,"pcpadd":"12006 Kilarney Dr","pcpcity":"Fredericksburg","pcpstate":"VA","pcpzip":224077207,"pcpcounty":"","pcpid":"","pcpname":"CHANCELLOR INTERNAL MEDICINE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"8016 CHERRY TREE DR","madd2":"","madd3":"","mcity":"FREDERICKSBURG","mstate":"VA","mzip":"22407-9998","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":[["","57237001930","DULOXETINE ","60MG","60.00","Select","Select",""],["","64764024060","AMITIZA ","24MCG","60.00","Select","Select",""],["","65862016801","ATENOLOL ","25MG","30.00","Select","Select",""],["","50228035490","PREGABALIN ","150MG","60.00","Select","Select",""],["","47781030701","NITROFUR ","50MG","60.00","Select","Select",""],["","57664050389","TIZANIDINE ","4MG","120.00","Select","Select",""],["","10702001801","OXYCODONE ","5MG","15.00","Select","Select",""],["","71930004612","OXYCOD\/APAP ","7.5-325","60.00","Select","Select",""],["","47781030301","NITROFURANTN ","100MG","28.00","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","LITE","100.00","Select","Select",""],["","65862050320","AMOX\/K ","875-125","24.00","Select","Select",""],["","00781261305","AMOXICILLIN ","500MG","42.00","Select","Select",""],["","62756014202","METFORMIN ","500MG ER","360.00","Select","Select",""],["","00143992801","CIPROFLOXACN ","500MG","20.00","Select","Select",""],["","68180030320","CEFUROXIME ","500MG","16.00","Select","Select",""],["","66689000816","NYSTATIN ","100000","200.00","Select","Select",""],["","65162052111","PROMETHAZINE ","25MG","90.00","Select","Select",""],["","00143314250","DOXYCYCL ","100MG","14.00","Select","Select",""],["","00093031401","KETOROLAC ","10MG","15.00","Select","Select",""],["","99073070805","FREESTYLE    MIS LITE","LITE","1.00","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","LANCETS","100.00","Select","Select",""],["","67877047380","LIDOCAINE ","5%","250.00","Select","Select",""],["","59762444002","METHYLPRED ","4MG","21.00","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}