{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"YOLANDA D GRAY","gend":1,"add":"1488 E TANNER CREEK DR","city":"NORFOLK","state":"VA","zip":"23513-9998","dob":"1984-01-10","age":"","mstatus":"","insh":"11002695","cliId":"","pno":7579209573,"cno":"","email":"","ename":"","eno":"","pphy":"ZAMANI, CHRISTOPHER R","ppno":7576865673,"pcpadd":"930 W 21st St Ste 100","pcpcity":"Norfolk","pcpstate":"VA","pcpzip":235171516,"pcpcounty":"","pcpid":"","pcpname":"GHENT STATION MEDICAL ASSOCIATES","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1488 E TANNER CREEK DR","madd2":"","madd3":"","mcity":"NORFOLK","mstate":"VA","mzip":"23513-9998","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":[["","70710113908","FLUCONAZOLE ","150MG","3.00","Select","Select",""],["","50111033401","METRONIDAZOL ","500MG","14.00","Select","Select",""],["","68180021709","LOSARTAN\/HCT ","100-25","90.00","Select","Select",""],["","11534018701","BUT\/APAP\/CAF ","","60.00","Select","Select",""],["","00093317431","ALBUTEROL ","E","8.50","Select","Select",""],["","57664047758","METOPROL ","50MG","180.00","Select","Select",""],["","00173060102","FLOVENT ","250MCG","60.00","Select","Select",""],["","65162019050","NAPROXEN ","500MG","45.00","Select","Select",""],["","00054034807","TINIDAZOLE ","500MG","8.00","Select","Select",""],["","45802071708","TERCONAZOLE ","80MG","3.00","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","18.00","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","90.00","Select","Select",""],["","68180016013","AZITHROMYCIN ","250MG","6.00","Select","Select",""],["","00603188016","LIDOCAINE ","5%","30.00","Select","Select",""],["","65862054990","VALSART\/HCTZ ","160-25MG","90.00","Select","Select",""],["","65162052110","PROMETHAZINE ","25MG","10.00","Select","Select",""],["","59310057922","PROAIR ","","8.50","Select","Select",""],["","65862085901","FAMOTIDINE ","20MG","180.00","Select","Select",""],["","00832105515","BACLOFEN ","20MG","90.00","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","14.00","Select","Select",""],["","57237001401","TAMSULOSIN ","0.4MG","7.00","Select","Select",""],["","52565004215","NYSTAT\/TRIAM ","","15.00","Select","Select",""],["","69097084507","CYCLOBENZAPR ","5MG","30.00","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":""}]}]}