{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BERNICE V FORD","gend":1,"add":"1911 Woodman Ct Apt D","city":"Glen Allen","state":"VA","zip":"23060-2925","dob":"1980-07-11","age":"","mstatus":"","insh":"11004175","cliId":"","pno":8044757065,"cno":8045493845,"email":"","ename":"","eno":"","pphy":"YOUNG, WILLIAM H","ppno":8043555550,"pcpadd":"110 N Robinson St Ste 301","pcpcity":"Richmond","pcpstate":"VA","pcpzip":232204461,"pcpcounty":"","pcpid":"","pcpname":"WILLIAM H YOUNG MD PC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1911 Woodman Ct Apt D","madd2":"","madd3":"","mcity":"Glen Allen","mstate":"VA","mzip":"23060-2925","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":[["","69097012303","TOPIRAMATE ","50MG","180.00","Select","Select",""],["","65862077685","MILI ","0.25\/35","28.00","Select","Select",""],["","00904636261","RISPERIDONE ","4MG","48.00","Select","Select",""],["","00904629261","ATORVASTATIN ","40MG","31.00","Select","Select",""],["","69315013801","BENZTROPINE ","2MG","8.00","Select","Select",""],["","51991074790","DULOXETINE ","30MG","30.00","Select","Select",""],["","70710113908","FLUCONAZOLE ","150MG","1.00","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16.00","Select","Select",""],["","68462040601","INDOMETHACIN ","25MG","80.00","Select","Select",""],["","50458056201","INVEGA ","117\/0.75","0.75","Select","Select",""],["","47781030301","NITROFURANTN ","100MG","10.00","Select","Select",""],["","16571020106","DICLOFENAC ","75MG DR","30.00","Select","Select",""],["","00173071920","FLOVENT ","110MCG","36.00","Select","Select",""],["","68382076010","METFORMIN ","1000MG","180.00","Select","Select",""],["","68180016013","AZITHROMYCIN ","250MG","6.00","Select","Select",""],["","49281042150","FLUZONE ","2021-22","0.50","Select","Select",""],["","00093005805","TRAMADOL ","50MG","12.00","Select","Select",""],["","60505265401","TRAZODONE ","100MG","14.00","Select","Select",""],["","65162090109","ARIPIPRAZOLE ","20MG","2.00","Select","Select",""],["","65862017760","CEFDINIR ","300MG","10.00","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21.00","Select","Select",""],["","70461042010","FLUCLVX ","2020-21","0.50","Select","Select",""],["","13668001005","CITALOPRAM ","20MG","90.00","Select","Select",""],["","51672130200","TERCONAZOLE ","0.80%","20.00","Select","Select",""],["","53746010901","HYDROCO\/APAP ","5-325MG","15.00","Select","Select",""],["","00093317431","ALBUTEROL ","E","25.50","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","30.00","Select","Select",""],["","69315090510","LORAZEPAM ","1MG","1.00","Select","Select",""],["","50111033401","METRONIDAZOL ","500MG","14.00","Select","Select",""],["","57664051083","MIRTAZAPINE ","7.5MG","90.00","Select","Select",""],["","00093720298","PRAVASTATIN ","40MG","30.00","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","14.00","Select","Select",""],["","59310057922","PROAIR ","","8.50","Select","Select",""],["","00832712401","DIVALPROEX ","500MG DR","47.00","Select","Select",""],["","00591565810","CYCLOBENZAPR ","10MG","90.00","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","12.00","Select","Select",""],["","43547028010","ESCITALOPRAM ","5MG","14.00","Select","Select",""],["","68462030929","NORGEST\/ETHI ","0.25\/35","28.00","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":""}]}]}