{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RAFAEL VALLADARES","gend":0,"add":"11410 MORAVIA ROAD","city":"MIDLOTHIAN","state":"VA","zip":"23112-9998","dob":"1951-09-15","age":"","mstatus":"","insh":"11006493","cliId":"","pno":8044052314,"cno":"","email":"","ename":"","eno":"","pphy":"VEDINA, ANNA","ppno":8047452200,"pcpadd":"9460 Amberdale Dr Ste A","pcpcity":"North Chesterfield","pcpstate":"VA","pcpzip":232361259,"pcpcounty":"","pcpid":"","pcpname":"JAMES RIVER INTERNISTS INC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"N","ano":"","add2":"","add3":"","madd1":"11410 MORAVIA ROAD","madd2":"","madd3":"","mcity":"MIDLOTHIAN","mstate":"VA","mzip":"23112-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"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":[["","33342006310","VALSARTAN ","80MG","23.00","Select","Select",""],["","49281012065","FLUZONE ","PF 20-21","0.70","Select","Select",""],["","29300012810","HYDROCHLOROT ","25MG","90.00","Select","Select",""],["","00093720298","PRAVASTATIN ","40MG","90.00","Select","Select",""],["","59762033302","LATANOPROST ","0.01%","7.50","Select","Select",""],["","68382013201","TAMSULOSIN ","0.4MG","90.00","Select","Select",""],["","68180072103","AMLODIPINE ","10MG","90.00","Select","Select",""],["","65162003416","OMEGA-3-ACID ","1GM","360.00","Select","Select",""],["","10572030201","PEG-3350\/KCL ","\/SODIUM","4,000.00","Select","Select",""],["","65862017760","CEFDINIR ","300MG","6.00","Select","Select",""],["","16571020150","DICLOFENAC ","75MG DR","20.00","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","10.00","Select","Select",""],["","00093031401","KETOROLAC ","10MG","30.00","Select","Select",""],["","00093226401","AMOXICILLIN ","875MG","20.00","Select","Select",""],["","65862007701","CIPROFLOXACN ","500MG","6.00","Select","Select",""],["","69238110305","IBUPROFEN ","800MG","20.00","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":""}]}]}