{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DENISE S MURDOCK","gend":1,"add":"1820 BREEZY POINT CIR APT 101","city":"NORTH CHESTERFIELD","state":"VA","zip":"23235-9998","dob":"1956-11-29","age":"","mstatus":"","insh":"11013811","cliId":"","pno":5704664771,"cno":"","email":"","ename":"","eno":"","pphy":"FELTY, DANNY W","ppno":7575362246,"pcpadd":"500 Hioaks Rd Ste B","pcpcity":"Richmond","pcpstate":"VA","pcpzip":232254061,"pcpcounty":"","pcpid":"","pcpname":"THE LAURELS OF BON AIR LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1820 BREEZY POINT CIR APT 101","madd2":"","madd3":"","mcity":"NORTH CHESTERFIELD","mstate":"VA","mzip":"23235-9998","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":[["","24208079535","NEO\/POLY\/DEX ","0.1% OP","3.50","Select","Select",""],["","68180047903","SIMVASTATIN ","20MG","90.00","Select","Select",""],["","33342007207","OLANZAPINE ","20MG","90.00","Select","Select",""],["","69097081312","GABAPENTIN ","100MG","360.00","Select","Select",""],["","60505006501","OMEPRAZOLE ","20MG","90.00","Select","Select",""],["","69238183007","LEVOTHYROXIN ","25MCG","90.00","Select","Select",""],["","61314064305","TOBRAMYCIN ","0.3% OP","5.00","Select","Select",""],["","55566410001","EUFLEXXA ","10MG\/ML","6.00","Select","Select",""],["","31722053401","METHOCARBAM ","750MG","60.00","Select","Select",""],["","68382091634","METHYLPRED ","4MG","21.00","Select","Select",""],["","00093321205","CLONAZEPAM ","1MG","180.00","Select","Select",""],["","69097052444","DICLOFENAC ","1%","100.00","Select","Select",""],["","65162062711","TRAMADOL ","50MG","30.00","Select","Select",""],["","52817033010","CYCLOBENZAPR ","5MG","90.00","Select","Select",""],["","00378113401","KETOROLAC ","10MG","20.00","Select","Select",""],["","60505057501","OLOPATADINE ","0.10%","5.00","Select","Select",""],["","65862018730","ONDANSETRON ","4MG","20.00","Select","Select",""],["","24208067004","SOD ","10% OP","15.00","Select","Select",""],["","52817032010","BACLOFEN ","10MG","30.00","Select","Select",""],["","69547035302","NARCAN ","","2.00","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":""}]}]}