{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMANDA J SIKAFFY","gend":1,"add":"8011 E CAMELLIA ROAD","city":"NORFOLK","state":"VA","zip":"23518-9998","dob":"1979-11-02","age":"","mstatus":"","insh":"11007747","cliId":"","pno":7574471993,"cno":7576517340,"email":"","ename":"","eno":"","pphy":"ALBAND, WENDY F","ppno":7577381200,"pcpadd":"4039 E Little Creek Rd","pcpcity":"Norfolk","pcpstate":"VA","pcpzip":235183549,"pcpcounty":"","pcpid":"","pcpname":"EAST BEACH MEDICAL ASSOCIATES","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"8011 E CAMELLIA ROAD","madd2":"","madd3":"","mcity":"NORFOLK","mstate":"VA","mzip":"23518-9998","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":[["","67877032105","IBUPROFEN ","800MG","60.00","Select","Select",""],["","68382025601","OXYBUTYNIN ","10MG ER","90.00","Select","Select",""],["","65162019050","NAPROXEN ","500MG","20.00","Select","Select",""],["","00093317431","ALBUTEROL ","E","8.50","Select","Select",""],["","00378967130","IPRATROPIUM\/ ","ALBUTER","90.00","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","30.00","Select","Select",""],["","00093310905","AMOXICILLIN ","500MG","28.00","Select","Select",""],["","59310057922","PROAIR ","","8.50","Select","Select",""],["","16571020106","DICLOFENAC ","75MG DR","20.00","Select","Select",""],["","43547034106","RISPERIDONE ","1MG","90.00","Select","Select",""],["","00591565810","CYCLOBENZAPR ","10MG","15.00","Select","Select",""],["","65862086001","FAMOTIDINE ","40MG","90.00","Select","Select",""],["","52565005504","CLOBETASOL ","0.05%","118.00","Select","Select",""],["","63304069205","CLINDAMYCIN ","150MG","28.00","Select","Select",""],["","00603233832","APAP\/CODEINE ","300-30MG","15.00","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","15.00","Select","Select",""],["","65862019405","FLUOXETINE ","40MG","90.00","Select","Select",""],["","43386035701","HYDROCO\/APAP ","7.5-325","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":""}]}]}