{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JENNIFER D SHORTER","gend":1,"add":"510 BELLFIELD DR","city":"NEWPORT NEWS","state":"VA","zip":"23608-9998","dob":"1972-12-18","age":"","mstatus":"","insh":"11012177","cliId":"","pno":7577521538,"cno":7577531538,"email":"","ename":"","eno":"","pphy":"BAGNALL, RICHARD D","ppno":7573452555,"pcpadd":"120 Kings Way Ste 1400","pcpcity":"Williamsburg","pcpstate":"VA","pcpzip":231852508,"pcpcounty":"","pcpid":"","pcpname":"RIVERSIDE WILLIAMSBURG FAMILY MEDICINE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"APT F","add3":"","madd1":"510 BELLFIELD DR","madd2":"APT F","madd3":"","mcity":"NEWPORT NEWS","mstate":"VA","mzip":"23608-9998","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":[["","31722072690","MONTELUKAST ","10MG","90.00","Select","Select",""],["","00172572960","FAMOTIDINE ","40MG","90.00","Select","Select",""],["","00023916360","RESTASIS ","0.05%","180.00","Select","Select",""],["","00406577101","METHADONE ","10MG","240.00","Select","Select",""],["","13107003134","MIRTAZAPINE ","15MG","15.00","Select","Select",""],["","68462015305","TOPIRAMATE ","50MG","60.00","Select","Select",""],["","69097052444","DICLOFENAC ","1%","100.00","Select","Select",""],["","29300012410","MELOXICAM ","7.5MG","10.00","Select","Select",""],["","33342008845","RIZATRIPTAN ","10MG","9.00","Select","Select",""],["","57237000511","FLUCONAZOLE ","150MG","2.00","Select","Select",""],["","27241009803","DULOXETINE ","30MG","14.00","Select","Select",""],["","68462010630","ONDANSETRON ","8MG","30.00","Select","Select",""],["","16729013816","CLONAZEPAM ","2MG","60.00","Select","Select",""],["","65862014836","SUMATRIPTAN ","100MG","9.00","Select","Select",""],["","00406052301","OXYCOD\/APAP ","10-325MG","90.00","Select","Select",""],["","00093768432","OLOPATADINE ","0.20%","2.50","Select","Select",""],["","67877024901","QUETIAPINE ","50MG","30.00","Select","Select",""],["","00378427677","VALACYCLOVIR ","1GM","14.00","Select","Select",""],["","10702000350","PROMETHAZINE ","25MG","90.00","Select","Select",""],["","51862094205","DIAZEPAM ","5MG","12.00","Select","Select",""],["","49502010202","EPINEPHRINE ","0.3MG","2.00","Select","Select",""],["","00591207030","LIDO\/PRILOCN ","2.5-2.5%","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":""}]}]}