{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHARITA J DANIELS","gend":1,"add":"1008 WOODHAVEN DRIVE","city":"RICHMOND","state":"VA","zip":"23224-9998","dob":"1966-09-05","age":"","mstatus":"","insh":"11000422","cliId":"","pno":8042315717,"cno":"","email":"","ename":"","eno":"","pphy":"JOSEPH, LERLA G","ppno":8042304913,"pcpadd":"849 S Sycamore St Ste A","pcpcity":"Petersburg","pcpstate":"VA","pcpzip":238035801,"pcpcounty":"","pcpid":"","pcpname":"CHARLES CITY MEDICAL GROUP","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1008 WOODHAVEN DRIVE","madd2":"","madd3":"","mcity":"RICHMOND","mstate":"VA","mzip":"23224-9998","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":[["","00406052301","OXYCOD\/APAP ","10-325MG","120.00","Select","Select",""],["","10702000350","PROMETHAZINE ","25MG","120.00","Select","Select",""],["","00378718505","METFORMIN ","500MG","180.00","Select","Select",""],["","00093317431","ALBUTEROL ","E","17.00","Select","Select",""],["","00781107905","ALPRAZOLAM ","1MG","90.00","Select","Select",""],["","68180016613","VANCOMYCIN ","125MG","56.00","Select","Select",""],["","59310057922","PROAIR ","","8.50","Select","Select",""],["","00093720198","PRAVASTATIN ","20MG","30.00","Select","Select",""],["","00406905076","FENTANYL ","50MCG\/HR","5.00","Select","Select",""],["","65862049101","QUETIAPINE ","100MG","30.00","Select","Select",""],["","00378623301","CITALOPRAM ","40MG","90.00","Select","Select",""],["","69547035302","NARCAN ","","2.00","Select","Select",""],["","00597007541","SPIRIVA ","HANDIHLR","30.00","Select","Select",""],["","43547029010","BUPROPION ","200MG SR","180.00","Select","Select",""],["","99073012050","FREESTYLE    TES","","100.00","Select","Select",""],["","31722072690","MONTELUKAST ","10MG","90.00","Select","Select",""],["","70010077001","METHOCARBAM ","750MG","30.00","Select","Select",""],["","57237000511","FLUCONAZOLE ","150MG","1.00","Select","Select",""],["","59651000205","OMEPRAZOLE ","20MG","90.00","Select","Select",""],["","00378210001","LOPERAMIDE ","2MG","10.00","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","READER","1.00","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","42.00","Select","Select",""],["","00173069600","ADVAIR ","250\/50","60.00","Select","Select",""],["","00054001829","PREDNISONE ","20MG","30.00","Select","Select",""],["","68382009601","HYDROXYCHLOR ","200MG","180.00","Select","Select",""],["","00781808926","AZITHROMYCIN ","250MG","6.00","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","90.00","Select","Select",""],["","57237002801","AMOXICILLIN ","500MG","20.00","Select","Select",""],["","68462019005","NAPROXEN ","500MG","60.00","Select","Select",""],["","55111018015","TIZANIDINE ","4MG","120.00","Select","Select",""],["","62559049001","DIPHEN\/ATROP ","2.5MG","20.00","Select","Select",""],["","00054353244","LORAZEPAM ","2MG\/ML","30.00","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","SENSOR","1.00","Select","Select",""],["","57237007710","ONDANSETRON ","4MG ODT","15.00","Select","Select",""],["","49502010202","EPINEPHRINE ","0.3MG","2.00","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","28.00","Select","Select",""],["","42858030101","HYDROMORPHON ","2MG","40.00","Select","Select",""],["","27808008201","MORPHINE ","100\/5ML","30.00","Select","Select",""],["","57599080300","FREESTY ","2 READER","1.00","Select","Select",""],["","16571020150","DICLOFENAC ","75MG DR","20.00","Select","Select",""],["","52015008001","DIFICID ","200MG","20.00","Select","Select",""],["","00093005805","TRAMADOL ","50MG","20.00","Select","Select",""],["","65862018601","CLINDAMYCIN ","300MG","40.00","Select","Select",""],["","52817033200","CYCLOBENZAPR ","10MG","21.00","Select","Select",""],["","00143992701","CIPROFLOXACN ","250MG","10.00","Select","Select",""],["","00093075701","PIROXICAM ","20MG","30.00","Select","Select",""],["","50383077932","LACTULOSE ","10GM\/15","700.00","Select","Select",""],["","65862053820","LEVOFLOXACIN ","750MG","10.00","Select","Select",""],["","00713052612","PROMETHEGAN ","25MG","18.00","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21.00","Select","Select",""],["","00093031401","KETOROLAC ","10MG","15.00","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":""}]}]}