{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOANNA M BOND","gend":1,"add":"463 COLLICELLO STREET","city":"HARRISONBURG","state":"VA","zip":"22802-3903","dob":"1975-03-14","age":"","mstatus":"","insh":"11016614","cliId":"","pno":5402821419,"cno":"","email":"","ename":"","eno":"","pphy":"MARIA A HERNANDEZ MD LLC","ppno":5404426144,"pcpadd":"129 University Blvd Ste E","pcpcity":"Harrisonburg","pcpstate":"VA","pcpzip":228013751,"pcpcounty":"","pcpid":"","pcpname":"MARIA A HERNANDEZ MD","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"463 COLLICELLO STREET","madd2":"","madd3":"","mcity":"HARRISONBURG","mstate":"VA","mzip":"22802-3903","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":[["","43547030203","ARIPIPRAZOLE ","2MG","30.00","Select","Select",""],["","00378181377","LEVOTHYROXIN ","125MCG","90.00","Select","Select",""],["","50111064801","FLUOXETINE ","20MG","30.00","Select","Select",""],["","65862049001","QUETIAPINE ","50MG","30.00","Select","Select",""],["","68180051303","LISINOPRIL ","5MG","30.00","Select","Select",""],["","00093005805","TRAMADOL ","50MG","180.00","Select","Select",""],["","24510005860","NUCYNTA ","50MG","60.00","Select","Select",""],["","64380097106","HYDROCORT ","10MG","75.00","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","14.00","Select","Select",""],["","00115703301","FLUDROCORT ","0.1MG","30.00","Select","Select",""],["","00115592201","PILOCARPINE ","5MG","180.00","Select","Select",""],["","00254302902","LUBIPROSTONE ","24MCG","60.00","Select","Select",""],["","08627001601","DEXCOM ","TRANSMIT","1.00","Select","Select",""],["","49281042150","FLUZONE ","2021-22","0.50","Select","Select",""],["","69097094312","GABAPENTIN ","300MG","90.00","Select","Select",""],["","00832054211","BUMETANIDE ","2MG","90.00","Select","Select",""],["","69097052444","DICLOFENAC ","1%","200.00","Select","Select",""],["","00054414622","CLOTRIMAZOLE ","10MG","70.00","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":""}]}]}