{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHESSIE I BROWN","gend":1,"add":"101 LIEUTENANT RUN DRIVE","city":"PETERSBURG","state":"VA","zip":"23805-9998","dob":"1966-05-03","age":"","mstatus":"","insh":"11001095","cliId":"","pno":8047049097,"cno":"","email":"","ename":"","eno":"","pphy":"ARMSTRONG, BRENT A","ppno":8045201110,"pcpadd":"815 W Poythress St","pcpcity":"Hopewell","pcpstate":"VA","pcpzip":238602532,"pcpcounty":"","pcpid":"","pcpname":"APPOMATTOX RIVER MEDICAL LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"APT A","add3":"","madd1":"101 LIEUTENANT RUN DRIVE","madd2":"APT A","madd3":"","mcity":"N DINWIDDIE","mstate":"VA","mzip":"23805-9998","pcpfaxno":"(804) 526-3105","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":[["","00406055201","OXYCODONE ","5MG","9.00","Select","Select",""],["","52817033200","CYCLOBENZAPR ","10MG","30.00","Select","Select",""],["","55111012205","ATORVASTATIN ","20MG","90.00","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","48.00","Select","Select",""],["","68180051902","LISINOP\/HCTZ ","20-12.5","60.00","Select","Select",""],["","00487950103","ALBUTEROL ","0.08%","540.00","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","90.00","Select","Select",""],["","65862037501","ESCITALOPRAM ","20MG","90.00","Select","Select",""],["","63304007601","POT  CHLORIDE","10MEQ ER","180.00","Select","Select",""],["","62175013643","OMEPRAZOLE ","40MG","30.00","Select","Select",""],["","00378335299","ESTRADIOL ","0.1MG","4.00","Select","Select",""],["","29300012510","MELOXICAM ","15MG","30.00","Select","Select",""],["","68462019005","NAPROXEN ","500MG","20.00","Select","Select",""],["","16729003510","ANASTROZOLE ","1MG","30.00","Select","Select",""],["","00378247401","DICLOFEN ","50MG","20.00","Select","Select",""],["","16714043901","NITROFURANTN ","100MG","6.00","Select","Select",""],["","16729003410","LETROZOLE ","2.5MG","90.00","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21.00","Select","Select",""],["","23155050105","HYDROXYZ ","25MG","60.00","Select","Select",""],["","45963070911","METOPROL ","25MG ER","90.00","Select","Select",""],["","64380080807","IBUPROFEN ","600MG","15.00","Select","Select",""],["","31722052001","HYDRALAZINE ","25MG","270.00","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}