{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BELINDA A GORDON","gend":1,"add":"2020 HOPKINS RD","city":"FREDERICKSBURG","state":"VA","zip":"22405-9998","dob":"1952-10-31","age":"","mstatus":"","insh":"11016854","cliId":"","pno":5406046777,"cno":"","email":"","ename":"","eno":"","pphy":"ALEXANDER, DAWN","ppno":5407109100,"pcpadd":"231 Garrisonville Rd Ste 101","pcpcity":"Stafford","pcpstate":"VA","pcpzip":225541604,"pcpcounty":"","pcpid":"","pcpname":"RAPPAHANNOCK FAMILY PHYSICIANS","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"202 Hopkins Rd","madd2":"","madd3":"","mcity":"Fredericksburg","mstate":"VA","mzip":"22405-2640","pcpfaxno":"(540) 373-0942","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":[["","00597010061","SPIRIVA ","2.5MCG","4.00","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","LANCETS","100.00","Select","Select",""],["","00093312501","DICLOXACILL ","500MG","40.00","Select","Select",""],["","62175061743","PANTOPRAZOLE ","40MG","180.00","Select","Select",""],["","99073070914","FREESTYLE    KIT FREEDOM","FREEDOM","1.00","Select","Select",""],["","60505384901","CELECOXIB ","200MG","60.00","Select","Select",""],["","00310009530","DALIRESP ","500MCG","90.00","Select","Select",""],["","00378827052","ALBUTEROL ","0.08%","75.00","Select","Select",""],["","00093342210","CYCLOBENZAPR ","10MG","60.00","Select","Select",""],["","00378932232","WIXELA ","500\/50","60.00","Select","Select",""],["","57664049983","MIRTAZAPINE ","15MG","30.00","Select","Select",""],["","00093770198","LEVOCETIRIZI ","5MG","30.00","Select","Select",""],["","00378021610","FUROSEMIDE ","40MG","90.00","Select","Select",""],["","70377000812","ROSUVASTATIN ","20MG","90.00","Select","Select",""],["","00378638001","VERAPAMIL ","180MG ER","180.00","Select","Select",""],["","99073070822","FREESTYLE    TES LITE","LITE","50.00","Select","Select",""],["","00093310905","AMOXICILLIN ","500MG","21.00","Select","Select",""],["","67877041401","METFORMIN ","750MG ER","90.00","Select","Select",""],["","68180030260","CEFUROXIME ","250MG","14.00","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","30.00","Select","Select",""],["","00406048401","APAP\/CODEINE ","300-30MG","20.00","Select","Select",""],["","68308015215","NYSTATIN ","100000","15.00","Select","Select",""],["","70710113908","FLUCONAZOLE ","150MG","1.00","Select","Select",""],["","43598029890","PREGABALIN ","300MG","60.00","Select","Select",""],["","64380076111","OMEGA-3-ACID ","1GM","360.00","Select","Select",""],["","49483060450","IBUPROFEN ","800MG","20.00","Select","Select",""],["","00143992701","CIPROFLOXACN ","250MG","14.00","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":["",""]}},{"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":""}]}]}