{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANNIE WOODY","gend":1,"add":"211 MARCELLA ROAD","city":"HAMPTON","state":"VA","zip":"23666-2675","dob":"1947-11-12","age":"","mstatus":"","insh":"11006288","cliId":"","pno":7572247160,"cno":"","email":"","ename":"","eno":"","pphy":"FELL, ROBERT SCOTT","ppno":7572512170,"pcpadd":"850 Enterprise Pkwy Ste 2200","pcpcity":"Hampton","pcpstate":"VA","pcpzip":236666252,"pcpcounty":"","pcpid":"","pcpname":"RIVERSIDE CENTER FOR INTERNAL MEDICINE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"APARTMENT 105","add3":"","madd1":"211 MARCELLA ROAD","madd2":"APARTMENT 105","madd3":"","mcity":"HAMPTON","mstate":"VA","mzip":"23666-2675","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":[["","00093031901","DILTIAZEM ","60MG","90.00","Select","Select",""],["","65862001205","SERTRALINE ","50MG","45.00","Select","Select",""],["","00023921105","COMBIGAN ","0.2\/0.5%","5.00","Select","Select",""],["","00023320503","LUMIGAN ","0.01%","5.00","Select","Select",""],["","69543038130","OLANZAPINE ","5MG","30.00","Select","Select",""],["","66993040732","CARBAMAZEPIN ","100MG ER","120.00","Select","Select",""],["","68180044601","QUETIAPINE ","50MG","30.00","Select","Select",""],["","52817033010","CYCLOBENZAPR ","5MG","30.00","Select","Select",""],["","64980051505","OFLOXACIN ","0.3% OP","5.00","Select","Select",""],["","00527133001","BACLOFEN ","10MG","15.00","Select","Select",""],["","00093553756","ESZOPICLONE ","1MG","30.00","Select","Select",""],["","65162010250","GABAPENTIN ","300MG","90.00","Select","Select",""],["","00121087316","LACTULOSE ","10GM\/15","473.00","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","42.00","Select","Select",""],["","00591024005","LORAZEPAM ","0.5MG","10.00","Select","Select",""],["","70461001903","FLUAD ","2019-20","0.50","Select","Select",""],["","69547035302","NARCAN ","","2.00","Select","Select",""],["","00591079501","DICYCLOMINE ","20MG","30.00","Select","Select",""],["","55111017915","TIZANIDINE ","2MG","45.00","Select","Select",""],["","69097052444","DICLOFENAC ","1%","100.00","Select","Select",""],["","59746012106","MECLIZINE ","25MG","30.00","Select","Select",""],["","68462010530","ONDANSETRON ","4MG","40.00","Select","Select",""],["","54838057280","CETIRIZINE ","1MG\/ML","240.00","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":""}]}]}