{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DANIEL M FOSTER","gend":1,"add":"728 PEACH GROVE ROAD","city":"Saint Stephens Church","state":"VA","zip":"23148-0093","dob":"1981-02-07","age":"","mstatus":"","insh":"11003743","cliId":"","pno":8042385471,"cno":"","email":"","ename":"","eno":"","pphy":"TSUI, ALLEN Y","ppno":8044435378,"pcpadd":"1362 Tappahannock Blvd","pcpcity":"Tappahannock","pcpstate":"VA","pcpzip":225609309,"pcpcounty":"","pcpid":"","pcpname":"TAPPAHANNOCK PRIMARY CARE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"N","ano":"","add2":"","add3":"","madd1":"728 PEACH GROVE ROAD","madd2":"","madd3":"","mcity":"Saint Stephens Church","mstate":"VA","mzip":"23148-0093","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":[["","76204020025","ALBUTEROL ","0.08%","300.00","Select","Select",""],["","00378021401","HALOPERIDOL ","2MG","10.00","Select","Select",""],["","64980032430","PROCTOZONE ","-HC 2.5%","30.00","Select","Select",""],["","47335071013","TOPIRAMATE ","50MG","180.00","Select","Select",""],["","52817081615","ACETIC ","2% OTIC","15.00","Select","Select",""],["","00093005301","BUSPIRONE ","5MG","90.00","Select","Select",""],["","63402030230","LATUDA ","20MG","30.00","Select","Select",""],["","00378180510","LEVOTHYROXIN ","75MCG","30.00","Select","Select",""],["","00469260130","MYRBETRIQ ","25MG","30.00","Select","Select",""],["","53885000810","ONETOUCH ","PLUS 33G","100.00","Select","Select",""],["","29300012601","BISOPROL ","5MG","90.00","Select","Select",""],["","45802088094","NYSTAT\/TRIAM ","","30.00","Select","Select",""],["","00169413212","OZEMPIC ","2\/1.5ML","1.50","Select","Select",""],["","59310057922","PROAIR ","","8.50","Select","Select",""],["","57237000630","FLUCONAZOLE ","200MG","30.00","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","20.00","Select","Select",""],["","51862006205","DIAZEPAM ","2MG","7.00","Select","Select",""],["","68462019005","NAPROXEN ","500MG","60.00","Select","Select",""],["","67877024901","QUETIAPINE ","50MG","7.00","Select","Select",""],["","00115168974","BUDESONIDE ","0.5MG\/2","540.00","Select","Select",""],["","69097052444","DICLOFENAC ","1%","100.00","Select","Select",""],["","60505014102","GLIPIZIDE ","5MG","90.00","Select","Select",""],["","00316022115","NYSTATIN ","100000","15.00","Select","Select",""],["","68645051554","AMLODIPINE ","5MG","90.00","Select","Select",""],["","65862014505","CARVEDILOL ","25MG","60.00","Select","Select",""],["","53746017801","METFORMIN ","500MG ER","90.00","Select","Select",""],["","00597015230","JARDIANCE ","10MG","30.00","Select","Select",""],["","51672128202","TRIAMCINOLON ","0.10%","30.00","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","473.00","Select","Select",""],["","47781030301","NITROFURANTN ","100MG","14.00","Select","Select",""],["","63304090090","FENOFIBRATE ","54MG","90.00","Select","Select",""],["","57237005920","CEFUROXIME ","500MG","14.00","Select","Select",""],["","57237004105","PENICILLN ","500MG","30.00","Select","Select",""],["","50111078751","AZITHROMYCIN ","250MG","6.00","Select","Select",""],["","53746051105","SPIRONOLACT ","25MG","90.00","Select","Select",""],["","00169430313","RYBELSUS ","3MG","30.00","Select","Select",""],["","43547034206","RISPERIDONE ","2MG","60.00","Select","Select",""],["","59651030830","FLUOXETINE ","10MG","90.00","Select","Select",""],["","00406051205","OXYCOD\/APAP ","5-325MG","15.00","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","21.00","Select","Select",""],["","58160084252","BOOSTRIX ","","0.50","Select","Select",""],["","68462018147","CLOTRIMAZOLE ","1%","45.00","Select","Select",""],["","68382050010","OMEPRAZOLE ","40MG","90.00","Select","Select",""],["","29300012810","HYDROCHLOROT ","25MG","90.00","Select","Select",""],["","33342006807","OLANZAPINE ","5MG","30.00","Select","Select",""],["","00781261305","AMOXICILLIN ","500MG","30.00","Select","Select",""],["","51672530200","CICLOPIROX ","8%","6.60","Select","Select",""],["","66685100100","AMOX\/K ","875-125","14.00","Select","Select",""],["","69238161606","OFLOXACIN ","0.3%OTIC","10.00","Select","Select",""],["","00006057761","JANUMET ","50-1000","60.00","Select","Select",""],["","52817033010","CYCLOBENZAPR ","5MG","60.00","Select","Select",""],["","00193658621","MICROLET ","LANCETS","100.00","Select","Select",""],["","70954000520","OXYBUTYNIN ","5MG","270.00","Select","Select",""],["","00193731221","CONTOUR ","NEXT","100.00","Select","Select",""],["","57237007710","ONDANSETRON ","4MG ODT","9.00","Select","Select",""],["","00378210001","LOPERAMIDE ","2MG","20.00","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","48.00","Select","Select",""],["","33342005407","PIOGLITAZONE ","15MG","90.00","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}