{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRENDA B BAILEY","gend":1,"add":"9612 KATHLEEN DR","city":"PETERSBURG","state":"VA","zip":"23803-9998","dob":"1956-12-05","age":"","mstatus":"","insh":"11004043","cliId":"","pno":8045368698,"cno":"","email":"","ename":"","eno":"","pphy":"JOLANTA A HERRERA MD PLLC","ppno":8045267990,"pcpadd":"2552 Aldridge Ave","pcpcity":"South Chesterfield","pcpstate":"VA","pcpzip":238345306,"pcpcounty":"","pcpid":"","pcpname":"JOLANTA A HERRERA MD PLLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"9612 KATHLEEN DR","madd2":"","madd3":"","mcity":"PETERSBURG","mstate":"VA","mzip":"23803-9998","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":[["","51672413101","LAMOTRIGINE ","100MG","15.00","Select","Select",""],["","65862001330","SERTRALINE ","100MG","60.00","Select","Select",""],["","42858010401","OXYCOD\/APAP ","10-325MG","120.00","Select","Select",""],["","70010075401","METHOCARBAM ","500MG","240.00","Select","Select",""],["","31722094301","HYDROCO\/APAP ","10-325MG","90.00","Select","Select",""],["","65162083366","DICLOFENAC ","1%","100.00","Select","Select",""],["","00143924920","AMOX\/K ","875-125","20.00","Select","Select",""],["","59746070501","CARISOPRODOL ","350MG","120.00","Select","Select",""],["","65862044830","VALACYCLOVIR ","500MG","6.00","Select","Select",""],["","10702005601","OXYCODONE ","10MG","60.00","Select","Select",""],["","55111018015","TIZANIDINE ","4MG","90.00","Select","Select",""],["","68462010340","FLUCONAZOLE ","150MG","1.00","Select","Select",""],["","69238110005","DOXYCYCL ","100MG","20.00","Select","Select",""],["","68462018147","CLOTRIMAZOLE ","1%","45.00","Select","Select",""],["","45802013970","METRONIDAZOL ","0.75%VAG","70.00","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":""}]}]}