{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MIRTIE B JONES","gend":1,"add":"169 JENKINS CHURCH RD","city":"CUMBERLAND","state":"VA","zip":"23040-9998","dob":"1960-01-28","age":"","mstatus":"","insh":"11015862","cliId":"","pno":8048368065,"cno":"","email":"","ename":"","eno":"","pphy":"BASHORE, RANDALL T","ppno":4345813271,"pcpadd":"2217 Princess Anne StSte 100-2","pcpcity":"Fredericksburg","pcpstate":"VA","pcpzip":224013359,"pcpcounty":"","pcpid":"","pcpname":"CAROLINE FAMILY PRACTICE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"169 JENKINS CHURCH RD","madd2":"","madd3":"","mcity":"CUMBERLAND","mstate":"VA","mzip":"23040-9998","pcpfaxno":"(434) 581-1105","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":[["","00186037020","SYMBICORT ","160-4.5","30.60","Select","Select",""],["","55111032001","GLIMEPIRIDE ","1MG","30.00","Select","Select",""],["","53489014305","SPIRONOLACT ","25MG","29.00","Select","Select",""],["","62756014202","METFORMIN ","500MG ER","120.00","Select","Select",""],["","68462018135","CLOTRIMAZOLE ","1%","30.00","Select","Select",""],["","68382077306","EZETIMIBE ","10MG","30.00","Select","Select",""],["","68180035302","SERTRALINE ","100MG","60.00","Select","Select",""],["","00093005105","CARVEDILOL ","3.125MG","120.00","Select","Select",""],["","00054429931","FUROSEMIDE ","40MG","27.00","Select","Select",""],["","29300022019","MONTELUKAST ","10MG","30.00","Select","Select",""],["","59310057922","PROAIR ","","8.50","Select","Select",""],["","00597007547","SPIRIVA ","HANDIHLR","90.00","Select","Select",""],["","62175013643","OMEPRAZOLE ","40MG","90.00","Select","Select",""],["","63304082805","ATORVASTATIN ","20MG","90.00","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":""}]}]}