{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JESSIE MICHL","gend":0,"add":"1097 TOLSTOY COURT","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1992-09-02","age":"","mstatus":"","insh":"11016973","cliId":"","pno":7034318173,"cno":"","email":"","ename":"","eno":"","pphy":"MEBRAHTU, SEMRET T","ppno":7576228358,"pcpadd":"150 Kingsley Ln Ste 4000","pcpcity":"Norfolk","pcpstate":"VA","pcpzip":235054602,"pcpcounty":"","pcpid":"","pcpname":"SENTARA MEDICAL GROUP","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"N","ano":"","add2":"","add3":"","madd1":"1097 TOLSTOY COURT","madd2":"","madd3":"","mcity":"VIRGINIA BEACH","mstate":"VA","mzip":"23454-9998","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":[["","00527133701","BACLOFEN ","20MG","120.00","Select","Select",""],["","65162010250","GABAPENTIN ","300MG","90.00","Select","Select",""],["","00185012201","NITROFURANTN ","100MG","14.00","Select","Select",""],["","60505265401","TRAZODONE ","100MG","90.00","Select","Select",""],["","67877024201","QUETIAPINE ","25MG","180.00","Select","Select",""],["","00406895301","AMPHET\/DEXTR ","15MG ER","30.00","Select","Select",""],["","43547028910","BUPROPION ","150MG SR","90.00","Select","Select",""],["","65862050220","AMOX\/K ","500-125","14.00","Select","Select",""],["","00143992801","CIPROFLOXACN ","500MG","14.00","Select","Select",""],["","68382073801","MIDODRINE ","5MG","180.00","Select","Select",""],["","45802014464","HC ","1-1%","30.00","Select","Select",""],["","00093005401","BUSPIRONE ","10MG","270.00","Select","Select",""],["","16571020150","DICLOFENAC ","75MG DR","60.00","Select","Select",""],["","51862094105","DIAZEPAM ","2MG","90.00","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","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":["",""]}},{"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":""}]}]}