{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRITTANY A ONEAL","gend":1,"add":"150 CLUBHOUSE DR SOUTH WEST","city":"LEESBURG","state":"VA","zip":"20175-9998","dob":"1986-04-10","age":"","mstatus":"","insh":"11017049","cliId":"","pno":5716451087,"cno":"","email":"","ename":"","eno":"","pphy":"AGGARWAL, RAJIV K","ppno":5712233833,"pcpadd":"19415 Deerfield Ave Ste 103","pcpcity":"Lansdowne","pcpstate":"VA","pcpzip":201768470,"pcpcounty":"","pcpid":"","pcpname":"LANSDOWNE TRAVEL AND FAMILY MEDICINE LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"APT 104","add3":"","madd1":"150 CLUBHOUSE DR SOUTH WEST","madd2":"APT 104","madd3":"","mcity":"LEESBURG","mstate":"VA","mzip":"20175-9998","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":[["","47781030301","NITROFURANTN ","100MG","14.00","Select","Select",""],["","33332032101","AFLURIA ","2021-22","0.50","Select","Select",""],["","51672126705","TRIAMCINOLON ","DEN 0.1%","5.00","Select","Select",""],["","70710113908","FLUCONAZOLE ","150MG","1.00","Select","Select",""],["","00378180310","LEVOTHYROXIN ","50MCG","90.00","Select","Select",""],["","63304069301","CLINDAMYCIN ","300MG","21.00","Select","Select",""],["","70954001910","PRAZOSIN ","1MG","90.00","Select","Select",""],["","59651000305","OMEPRAZOLE ","40MG","90.00","Select","Select",""],["","68001045508","ESCITALOPRAM ","10MG","45.00","Select","Select",""],["","00378827052","ALBUTEROL ","0.08%","75.00","Select","Select",""],["","65862007701","CIPROFLOXACN ","500MG","3.00","Select","Select",""],["","67877032005","IBUPROFEN ","600MG","20.00","Select","Select",""],["","68308015215","NYSTATIN ","100000","15.00","Select","Select",""],["","13107005999","APAP\/CODEINE ","300-30MG","16.00","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","473.00","Select","Select",""],["","10702025350","BUT\/APAP\/CAF ","","15.00","Select","Select",""],["","10702000710","CYCLOBENZAPR ","10MG","15.00","Select","Select",""],["","68001040103","FLUOXETINE ","40MG","90.00","Select","Select",""],["","13107003134","MIRTAZAPINE ","15MG","15.00","Select","Select",""],["","50742061510","METOPROL ","25MG ER","90.00","Select","Select",""],["","23155013525","DOXYCYC ","100MG","14.00","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","28.00","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":""}]}]}