{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CYNTHIA CARTER","gend":1,"add":"1609 EDWARDS AVENUE","city":"RICHMOND","state":"VA","zip":"23224-9998","dob":"1953-09-20","age":"","mstatus":"","insh":"11013563","cliId":"","pno":8042776262,"cno":"","email":"","ename":"","eno":"","pphy":"DELAHOUSSAYE, ALADEE R","ppno":7578748400,"pcpadd":"4714 Marshall Ave","pcpcity":"Newport News","pcpstate":"VA","pcpzip":236072247,"pcpcounty":"","pcpid":"","pcpname":"CHESAPEAKE COMMUNITY HEALTH CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1609 EDWARDS AVENUE","madd2":"","madd3":"","mcity":"RICHMOND","mstate":"VA","mzip":"23224-9998","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":[["","60505024801","MIRTAZAPINE ","30MG","90.00","Select","Select",""],["","29033000305","SUCRALFATE ","1GM","120.00","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","LITE","100.00","Select","Select",""],["","17478007035","ERYTHROMYCIN ","5MG\/GM","3.50","Select","Select",""],["","64380078706","BUSPIRONE ","7.5MG","90.00","Select","Select",""],["","68645051654","AMLODIPINE ","10MG","45.00","Select","Select",""],["","00093005805","TRAMADOL ","50MG","28.00","Select","Select",""],["","63304069205","CLINDAMYCIN ","150MG","42.00","Select","Select",""],["","31722071390","PANTOPRAZOLE ","40MG","60.00","Select","Select",""],["","00555032302","HYDROXYZ ","25MG","60.00","Select","Select",""],["","57237002801","AMOXICILLIN ","500MG","21.00","Select","Select",""],["","68645056354","IBUPROFEN ","800MG","24.00","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","LANCETS","100.00","Select","Select",""],["","00088221905","LANTUS ","100\/ML","15.00","Select","Select",""],["","00093220401","METOCLOPRAM ","5MG","40.00","Select","Select",""],["","66733082259","INSULIN ","100\/ML","15.00","Select","Select",""],["","10702000709","CYCLOBENZAPR ","10MG","30.00","Select","Select",""],["","08290320122","BD  PEN NEEDL","32GX4MM","100.00","Select","Select",""],["","45802008801","ALBUTEROL ","HFA","8.50","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","21.00","Select","Select",""],["","57237007710","ONDANSETRON ","4MG ODT","10.00","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}