{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LINDA YOUNG","gend":1,"add":"2400 BURTON STREET","city":"RICHMOND","state":"VA","zip":"23223-6468","dob":"1956-10-06","age":"","mstatus":"","insh":"11000045","cliId":"","pno":8043250059,"cno":"","email":"","ename":"","eno":"","pphy":"DICKERSON, TASHA B","ppno":8042257177,"pcpadd":"304 E LEIGH ST","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":232191410,"pcpcounty":"","pcpid":"","pcpname":"DOMINION MEDICAL ASSOCIATES","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"APT 411","add3":"","madd1":"2400 BURTON STREET","madd2":"APT 411","madd3":"","mcity":"RICHMOND","mstate":"VA","mzip":"23223-6468","pcpfaxno":"(804) 237-0362","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":[["","00406012405","HYDROCO\/APAP ","7.5-325","120.00","Select","Select",""],["","57237007710","ONDANSETRON ","4MG ODT","10.00","Select","Select",""],["","00378161001","DICYCLOMINE ","10MG","15.00","Select","Select",""],["","59651000205","OMEPRAZOLE ","20MG","30.00","Select","Select",""],["","65862056090","PANTOPRAZOLE ","40MG","90.00","Select","Select",""],["","62756052169","SUMATRIPTAN ","50MG","9.00","Select","Select",""],["","68382004110","PROMETHAZINE ","25MG","30.00","Select","Select",""],["","13107003134","MIRTAZAPINE ","15MG","30.00","Select","Select",""],["","00406048410","APAP\/CODEINE ","300-30MG","50.00","Select","Select",""],["","52817033200","CYCLOBENZAPR ","10MG","60.00","Select","Select",""],["","00406051205","OXYCOD\/APAP ","5-325MG","12.00","Select","Select",""],["","70010077001","METHOCARBAM ","750MG","12.00","Select","Select",""],["","65862090801","CELECOXIB ","100MG","60.00","Select","Select",""],["","65162010250","GABAPENTIN ","300MG","90.00","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21.00","Select","Select",""],["","00713064015","HALOBETASOL ","0.05%","60.00","Select","Select",""],["","68462024805","RANITIDINE ","150MG","20.00","Select","Select",""],["","50111044101","TRAZODONE ","150MG","30.00","Select","Select",""],["","57237000511","FLUCONAZOLE ","150MG","1.00","Select","Select",""],["","00713052612","PROMETHEGAN ","25MG","12.00","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","28.00","Select","Select",""],["","65862085901","FAMOTIDINE ","20MG","20.00","Select","Select",""],["","64380080807","IBUPROFEN ","600MG","20.00","Select","Select",""],["","59310057922","PROAIR ","","8.50","Select","Select",""],["","69097052444","DICLOFENAC ","1%","500.00","Select","Select",""],["","69315090505","LORAZEPAM ","1MG","2.00","Select","Select",""],["","65162062711","TRAMADOL ","50MG","12.00","Select","Select",""],["","43547038003","DULOXETINE ","30MG","30.00","Select","Select",""],["","10702005601","OXYCODONE ","10MG","3.00","Select","Select",""],["","00071101568","LYRICA ","100MG","60.00","Select","Select",""],["","00093220401","METOCLOPRAM ","5MG","28.00","Select","Select",""],["","00316022130","NYSTATIN ","100000","60.00","Select","Select",""],["","58160081912","SHINGRIX ","50MCG","1.00","Select","Select",""],["","59746011506","PROCHLORPER ","10MG","21.00","Select","Select",""],["","51672128402","TRIAMCINOLON ","0.10%","60.00","Select","Select",""],["","00378034505","DIAZEPAM ","5MG","9.00","Select","Select",""],["","00093317431","ALBUTEROL ","E HFA INH","42.50","Select","Select",""],["","00093221005","SUCRALFATE ","1GM","120.00","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":["",""],"sub":{"indx":[["","",""],[""],[""],[""],[""]],"comment":[["","",""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}