{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRENDA D FELTON","gend":1,"add":"1259 HANSON AVE #D","city":"NORFOLK","state":"VA","zip":"23504-2959","dob":"1955-06-21","age":"","mstatus":"","insh":"11014833","cliId":"","pno":7573093530,"cno":7576220256,"email":"","ename":"","eno":"","pphy":"HUMADI, SAHIRA A","ppno":7574465955,"pcpadd":"1701 High St Fl 1","pcpcity":"Portsmouth","pcpstate":"VA","pcpzip":237043103,"pcpcounty":"","pcpid":"","pcpname":"EVMS HEALTH SERVICES","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"5432 Tidewater Dr Apt S216","madd2":"","madd3":"","mcity":"Norfolk","mstate":"VA","mzip":"23509-1462","pcpfaxno":"(757) 446-5624","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":[["","63304069301","CLINDAMYCIN ","300MG","28.00","Select","Select",""],["","49483060610","GABAPENTIN ","300MG","90.00","Select","Select",""],["","16714087502","ATORVASTATIN ","20MG","30.00","Select","Select",""],["","59746021106","CYCLOBENZAPR ","5MG","30.00","Select","Select",""],["","65862057490","MONTELUKAST ","10MG","30.00","Select","Select",""],["","00003089421","ELIQUIS ","5MG","60.00","Select","Select",""],["","62756014202","METFORMIN ","500MG ER","120.00","Select","Select",""],["","57599080300","FREESTY ","2 READER","1.00","Select","Select",""],["","51672128402","TRIAMCINOLON ","0.10%","60.00","Select","Select",""],["","00093317431","ALBUTEROL ","E","8.50","Select","Select",""],["","00169413602","OZEMPIC ","2\/1.5ML","3.00","Select","Select",""],["","00088222033","LANTUS ","100\/ML","10.00","Select","Select",""],["","76282066339","DICLOFENAC ","1%","100.00","Select","Select",""],["","31722070110","LOSARTAN ","50MG","30.00","Select","Select",""],["","16714012303","OMEPRAZOLE ","40MG","60.00","Select","Select",""],["","57599157701","FREESTYLE    TES PREC NEO","PREC NEO","25.00","Select","Select",""],["","29300012810","HYDROCHLOROT ","25MG","30.00","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","LANCETS","100.00","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16.00","Select","Select",""],["","56151173301","INSULIN ","1ML\/31G","100.00","Select","Select",""],["","99073071231","FREESTYLE    TES INSULINX","INSULINX","100.00","Select","Select",""],["","10702019001","HYDROCO\/APAP ","7.5-325","15.00","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":""}]}]}