{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANGELA MORROW","gend":1,"add":"864 CHARLOTTE ST","city":"NORFOLK","state":"VA","zip":"23504-9998","dob":"1980-07-15","age":"","mstatus":"","insh":"11004916","cliId":"","pno":7574703407,"cno":7579434881,"email":"","ename":"","eno":"","pphy":"BUMANGLAG, LEILA","ppno":7572782240,"pcpadd":"155 Kingsley Ln Ste 400","pcpcity":"Norfolk","pcpstate":"VA","pcpzip":235054629,"pcpcounty":"","pcpid":"","pcpname":"DEPAUL MEDICAL ASSOCIATES","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"APT 2","add3":"","madd1":"864 CHARLOTTE ST","madd2":"APT 2","madd3":"","mcity":"NORFOLK","mstate":"VA","mzip":"23504-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["ASIAN\/PACIFIC"]],"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":[["","31722055190","LEVOCETIRIZI ","5MG","30.00","Select","Select",""],["","42571013725","KETOROLAC ","0.50%","10.00","Select","Select",""],["","00143980305","DOXYCYCL ","100MG","20.00","Select","Select",""],["","24208091055","ERYTHROMYCIN ","OP","3.50","Select","Select",""],["","29300022010","MONTELUKAST ","10MG","30.00","Select","Select",""],["","00168025846","CLOTRIM\/BETA ","DIPROP","45.00","Select","Select",""],["","67877021905","CEPHALEXIN ","500MG","14.00","Select","Select",""],["","70377000911","ROSUVASTATIN ","40MG","30.00","Select","Select",""],["","57237000511","FLUCONAZOLE ","150MG","2.00","Select","Select",""],["","61314063705","PREDNISOLONE ","1% OP","5.00","Select","Select",""],["","60505257808","ATORVASTATIN ","10MG","30.00","Select","Select",""],["","55111028050","LEVOFLOXACIN ","500MG","14.00","Select","Select",""],["","00088221905","LANTUS ","100\/ML","15.00","Select","Select",""],["","00591024010","LORAZEPAM ","0.5MG","60.00","Select","Select",""],["","00002882427","HUMULIN ","U-500","18.00","Select","Select",""],["","43547028211","ESCITALOPRAM ","20MG","30.00","Select","Select",""],["","55111018010","TIZANIDINE ","4MG","60.00","Select","Select",""],["","45802049326","AMMONIUM ","12%","385.00","Select","Select",""],["","50111039701","HYDRALAZINE ","100MG","60.00","Select","Select",""],["","00093005405","BUSPIRONE ","10MG","60.00","Select","Select",""],["","13668001005","CITALOPRAM ","20MG","30.00","Select","Select",""],["","52565001951","AUG ","0.05%","50.00","Select","Select",""],["","61314001910","DORZOLAMIDE ","2% OP","10.00","Select","Select",""],["","45802006405","TRIAMCINOLON ","0.10%","80.00","Select","Select",""],["","67877041920","LINEZOLID ","600MG","28.00","Select","Select",""],["","47781019601","OXYCOD\/APAP ","5-325MG","5.00","Select","Select",""],["","68180087673","NORETHINDRON ","0.35MG","28.00","Select","Select",""],["","54879000460","BETAMETH ","0.10%","60.00","Select","Select",""],["","45963067696","METOPROL ","50MG ER","30.00","Select","Select",""],["","45802046564","KETOCONAZOLE ","2%","120.00","Select","Select",""],["","51672131200","MUPIROCIN ","2%","22.00","Select","Select",""],["","00228212850","CLONIDINE ","0.2MG","30.00","Select","Select",""],["","53746027205","SMZ\/TMP ","800-160","20.00","Select","Select",""],["","68308015260","NYSTATIN ","100000","60.00","Select","Select",""],["","56151147002","TRUE ","METER","1.00","Select","Select",""],["","00169413602","OZEMPIC ","2\/1.5ML","2.00","Select","Select",""],["","16571041250","CIPROFLOXACN ","500MG","14.00","Select","Select",""],["","00037024523","DYMISTA ","137-50","23.00","Select","Select",""],["","69097012815","AMLODIPINE ","10MG","90.00","Select","Select",""],["","00456430001","MONUROL ","GRANULES","1.00","Select","Select",""],["","00781261305","AMOXICILLIN ","500MG","20.00","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","20.00","Select","Select",""],["","45802000910","FLUOCIN ","0.01%","20.00","Select","Select",""],["","23155065201","METRONIDAZOL ","500MG","10.00","Select","Select",""],["","63304069201","CLINDAMYCIN ","150MG","84.00","Select","Select",""],["","00023932105","ALPHAGAN ","0.10%","5.00","Select","Select",""],["","33332031901","AFLURIA ","2019-20","0.50","Select","Select",""],["","68382079105","ACYCLOVIR ","400MG","30.00","Select","Select",""],["","00093227534","AMOX\/K ","875-125","7.00","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21.00","Select","Select",""],["","00832046560","NYAMYC ","100000","60.00","Select","Select",""],["","47781030301","NITROFURANTN ","100MG","14.00","Select","Select",""],["","59746032430","VALACYCLOVIR ","500MG","30.00","Select","Select",""],["","08214384034","UNIFINE ","32GX5\/32","200.00","Select","Select",""],["","70010075401","METHOCARBAM ","500MG","90.00","Select","Select",""],["","61314027105","OLOPATADINE ","0.1% OPTH","5.00","Select","Select",""],["","68180065208","DOXYCYC ","100MG","20.00","Select","Select",""],["","68180051703","LISINOPRIL ","40MG","180.00","Select","Select",""],["","00169183311","NOVOLIN ","U-100","10.00","Select","Select",""],["","51672130200","TERCONAZOLE ","0.80%","20.00","Select","Select",""],["","57237001930","DULOXETINE ","60MG","30.00","Select","Select",""],["","61442012201","FAMOTIDINE ","40MG","30.00","Select","Select",""],["","56151085050","TRUETRACK ","","200.00","Select","Select",""],["","00193731150","CONTOUR ","NEXT","200.00","Select","Select",""],["","00168008016","HYDROCORT ","2.50%","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":""}]}]}