{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MELISSA   E SCALES","gend":1,"add":"3738 SANDPIPER ROAD UNIT 426","city":"VIRGINIA BEACH","state":"VA","zip":"23456-9998","dob":"1961-10-30","age":"","mstatus":"","insh":"900031975*01","cliId":"9VD3X27PW08","pno":"757\/971-4414","cno":"757\/971-4414","email":"","ename":"","eno":"","pphy":"PATTERSON, JOHN ROBERT MD","ppno":"248\/824-6003","pcpadd":"236 CLEARFIELD AVE STE 215","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23464,"pcpcounty":"","pcpid":159520,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"TIDEWATER","aligned":"","ano":"757\/971-4414","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":[]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","00093221005","","1GM","-42","Select","Select",""],["","55111015930","OMEPRAZOLE","40MG","60","Select","Select",""],["","00093005805","TRAMADOL","50MG","90","Select","Select",""],["","00093221005","SUCRALFATE","1GM","-42","Select","Select",""],["","71093011105","GABAPENTIN","600MG","120","Select","Select",""],["","00781518292","LEVOTHYROXIN","75MCG","-270","Select","Select",""],["","00169750111","NOVOLOG","100\/ML","60","Select","Select",""],["","63323060584","ENOXAPARIN","100MG\/ML","-60","Select","Select",""],["","00832532510","POT CL MICRO","20MEQ ER","60","Select","Select",""],["","10702005601","OXYCODONE","10MG","-10","Select","Select",""],["","65649030302","XIFAXAN","550MG","60","Select","Select",""],["","57237012201","WARFARIN","3MG","-30","Select","Select",""],["","00088222033","LANTUS","100\/ML","10","Select","Select",""],["","43547040211","FUROSEMIDE","40MG","-120","Select","Select",""],["","00378190301","MIDODRINE","10MG","90","Select","Select",""],["","50383077916","LACTULOSE","10GM\/15","-473","Select","Select",""],["","16714083301","BUMETANIDE","2MG","-60","Select","Select",""],["","16714076901","NYSTATIN","100000","15","Select","Select",""],["","59746021601","SPIRONOLACT","25MG","90","Select","Select",""],["","55111015330","ONDANSETRON","4MG","50","Select","Select",""],["","57237001830","DULOXETINE","30MG","180","Select","Select",""],["","72140045231","AQUAPHOR","","50","Select","Select",""],["","43598021025","SSD","1%","25","Select","Select",""],["","65862008501","CEFADROXIL","500MG","20","Select","Select",""],["","00406800315","MORPHINE","100\/5ML","15","Select","Select",""],["","73070010011","INSULIN","100\/ML","60","Select","Select",""],["","58657067601","CIPROFLOXACN","500MG","14","Select","Select",""],["","65162027250","SMZ\/TMP","800-160","14","Select","Select",""],["","59011041010","OXYCONTIN","10MG CR","20","Select","Select",""],["","68382039801","POT CHLORIDE","20MEQ ER","14","Select","Select",""],["","45963043963","CONSTULOSE","10GM\/15","236","Select","Select",""],["","57599000200","FREESTYLE MIS READER","READER","1","Select","Select",""],["","65162083366","DICLOFENAC","1%","100","Select","Select",""],["","57599000101","FREESTYLE KIT SENSOR","SENSOR","6","Select","Select",""],["","24510005860","NUCYNTA","50MG","60","Select","Select",""],["","67877021560","CEFUROXIME","250MG","20","Select","Select",""],["","72305015030","EUTHYROX","150MCG","30","Select","Select",""],["","31722094101","HYDROCO\/APAP","5-325MG","10","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","10","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}