{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SALINDA ALVIN","gend":1,"add":"926 CHUMLEY RD APT B","city":"PORTSMOUTH","state":"VA","zip":"23701-9998","dob":"1954-08-11","age":"","mstatus":"","insh":"11009378","cliId":"","pno":7572271998,"cno":7572771998,"email":"","ename":"","eno":"","pphy":"ABDELSHAHEED, SAMIR T","ppno":7574883333,"pcpadd":"6111 PORTSMOUTH BLVD","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":237011445,"pcpcounty":"","pcpid":"","pcpname":"FAMILY MEDICINE HEALTH CARE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"926 CHUMLEY RD APT B","madd2":"","madd3":"","mcity":"PORTSMOUTH","mstate":"VA","mzip":"23701-9998","pcpfaxno":"(757) 499-0007","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":[["","16714008110","HYDROXYZ ","10MG","15.00","Select","Select",""],["","29300022010","MONTELUKAST ","10MG","30.00","Select","Select",""],["","00093317431","ALBUTEROL ","E","8.50","Select","Select",""],["","00069046903","CHANTIX ","1MG","56.00","Select","Select",""],["","61958190101","GENVOYA ","","30.00","Select","Select",""],["","00310737020","BUDES\/FORMOT ","160-4.5","10.20","Select","Select",""],["","00591046210","METOPROL ","50MG","30.00","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","20.00","Select","Select",""],["","51862044601","TAMOXIFEN ","20MG","90.00","Select","Select",""],["","31722077705","ACYCLOVIR ","400MG","30.00","Select","Select",""],["","69315031228","PROCTO-MED ","HC 2.5%","28.00","Select","Select",""],["","45963043965","CONSTULOSE ","10GM\/15","946.00","Select","Select",""],["","16714043901","NITROFURANTN ","100MG","10.00","Select","Select",""],["","50383070016","FLUTICASONE ","50MCG","16.00","Select","Select",""],["","00597010061","SPIRIVA ","2.5MCG","4.00","Select","Select",""],["","69547035302","NARCAN ","","2.00","Select","Select",""],["","66993058597","FLUTIC\/SALME ","250\/50","60.00","Select","Select",""],["","00904585540","IBUPROFEN ","800MG","60.00","Select","Select",""],["","59762306001","AZITHROMYCIN ","250MG","6.00","Select","Select",""],["","00054001725","PREDNISONE ","10MG","20.00","Select","Select",""],["","60505083305","AZELASTINE ","0.10%","30.00","Select","Select",""],["","49281012165","FLUZONE ","2021-22","0.70","Select","Select",""],["","29300022701","METRONIDAZOL ","500MG","4.00","Select","Select",""],["","50383077932","LACTULOSE ","10GM\/15","946.00","Select","Select",""],["","00168009930","KETOCONAZOLE ","2%","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}