{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LESLIE   L MOORE","gend":0,"add":"602 MECKLENBURG AVE","city":"VICTORIA","state":"VA","zip":"23974-9998","dob":"1955-11-14","age":"","mstatus":"","insh":"900049315*01","cliId":"6UQ9XE5KD53","pno":"757\/692-7133","cno":"757\/692-7133","email":"","ename":"","eno":"","pphy":"PHYSICIAN, MR PRIMARY CARE MD","ppno":"","pcpadd":"4417 CORPORATION LANE","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":"799MR","pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","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":[["","00378064110","PREDNISONE","10MG","30","Select","Select",""],["","00173088710","TRELEGY ELLIPTA","ELLIPTA","60","Select","Select",""],["","23155002305","BUSPIRONE HYDROCHLORIDE","5MG","30","Select","Select",""],["","68180098003","LISINOPRIL","10MG","90","Select","Select",""],["","00143992801","CIPROFLOXACIN HYDROCHLORIDE","500MG","60","Select","Select",""],["","16729021816","CLOPIDOGREL","75MG","90","Select","Select",""],["","00378064110","PREDNISONE                                                            ","TAB 10MG","30","Select","Select",""],["","69315012710","FOLIC ACID                                                            ","TAB 1000MCG","90","Select","Select",""],["","68180098003","LISINOPRIL                                                            ","TAB 10MG","90","Select","Select",""],["","16729021816","CLOPIDOGREL                                                           ","TAB 75MG","90","Select","Select",""],["","00173088710","TRELEGY ELLIPTA                                                       ","AER ELLIPTA","60","Select","Select",""],["","23155002305","BUSPIRONE HYDROCHLORIDE                                               ","TAB 5MG","30","Select","Select",""],["","69315015510","HYDROCHLOROTHIAZIDE                                                   ","TAB 12.5MG","30","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE                                                ","SPR 50MCG","16","Select","Select",""],["","00143992801","CIPROFLOXACIN HYDROCHLORIDE                                           ","TAB 500MG","60","Select","Select",""],["","65862059805","TAMSULOSIN HYDROCHLORIDE                                              ","CAP 0.4MG","60","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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","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":""}]}]}