{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EVELYN R CARTER","gend":1,"add":"1402 BRUCE STREET","city":"RICHMOND","state":"VA","zip":"23224-7524","dob":"1963-01-15","age":"","mstatus":"","insh":"11004099","cliId":"","pno":8043095289,"cno":8043095774,"email":"","ename":"","eno":"","pphy":"REYNOLDS-CANE, DIANNE LENA","ppno":8047800840,"pcpadd":"2809 North Ave Ste 206","pcpcity":"Richmond","pcpstate":"VA","pcpzip":232223647,"pcpcounty":"","pcpid":"","pcpname":"NORTHSIDE MEDICAL CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1402 BRUCE STREET","madd2":"","madd3":"","mcity":"RICHMOND","mstate":"VA","mzip":"23224-7524","pcpfaxno":"(804) 780-0862","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":[["","43975032303","TOLTERODINE ","4MG ER","90.00","Select","Select",""],["","00093317431","ALBUTEROL ","E","8.50","Select","Select",""],["","60505083001","MOMETASONE ","50MCG","51.00","Select","Select",""],["","00591505210","PREDNISONE ","5MG","90.00","Select","Select",""],["","00173088210","BREO ","200-25","60.00","Select","Select",""],["","65862078430","ESOMEPRA ","40MG DR","90.00","Select","Select",""],["","00597007541","SPIRIVA ","HANDIHLR","90.00","Select","Select",""],["","61314022705","TIMOLOL ","0.5% OP","5.00","Select","Select",""],["","59310057922","PROAIR ","","25.50","Select","Select",""],["","16714008212","HYDROXYZ ","25MG","90.00","Select","Select",""],["","16714087603","ATORVASTATIN ","40MG","30.00","Select","Select",""],["","65862057490","MONTELUKAST ","10MG","90.00","Select","Select",""],["","00487020160","IPRATROPIUM\/ ","ALBUTER","1,080.00","Select","Select",""],["","60505017007","PRAVASTATIN ","40MG","90.00","Select","Select",""],["","16714085201","METOPROL ","25MG ER","45.00","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","14.00","Select","Select",""],["","50111078766","AZITHROMYCIN ","250MG","36.00","Select","Select",""],["","55111017915","TIZANIDINE ","2MG","270.00","Select","Select",""],["","58160088552","FLUARIX ","2020-21","0.50","Select","Select",""],["","00469260130","MYRBETRIQ ","25MG","30.00","Select","Select",""],["","31722071390","PANTOPRAZOLE ","40MG","90.00","Select","Select",""],["","10572010001","PEG-3350 ","ELECTROL","4,000.00","Select","Select",""],["","52817033200","CYCLOBENZAPR ","10MG","30.00","Select","Select",""],["","65862050320","AMOX\/K ","875-125","14.00","Select","Select",""],["","42806031250","DOXYCYCL ","100MG","14.00","Select","Select",""],["","31722072250","LEVOFLOXACIN ","500MG","5.00","Select","Select",""],["","00406048410","APAP\/CODEINE ","300-30MG","12.00","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":""}]}]}