{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" A ALLEDREITTOL","gend":1,"add":"EERG 506TC WEIVN","city":"PULASKI","state":"VA","zip":"24301-9998","dob":"1976-02-14","age":"","mstatus":"","insh":"00110071","cliId":"","pno":"0504532915","cno":5405777044,"email":"","ename":"","eno":"","pphy":"BROCHERO, ALFONSO D","ppno":5407693964,"pcpadd":"2900 LAMB CIRCLE","pcpcity":"CHRISTIANSBURG","pcpstate":"VA","pcpzip":240736344,"pcpcounty":"","pcpid":"","pcpname":"PULASKI HEALTH AND REHAB CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"605 GREENVIEW CT","madd2":"","madd3":"","mcity":"PULASKI","mstate":"VA","mzip":"24301-9998","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":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","68462024805","RANITIDINE","TAB 150MG","180.00","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","21.00","Select","Select",""],["","65162052110","PROMETHAZINE","TAB 25MG","30.00","Select","Select",""],["","68462029817","CLOTRIM\/BETA","CRE DIPROP","15.00","Select","Select",""],["","65862044830","VALACYCLOVIR","TAB 500MG","60.00","Select","Select",""],["","68180044801","QUETIAPINE","TAB 200MG","90.00","Select","Select",""],["","51672128402","TRIAMCINOLON","OIN 0.001","30.00","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","90.00","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","180.00","Select","Select",""],["","60505265401","TRAZODONE","TAB 100MG","30.00","Select","Select",""],["","16571020210","DICLOFENAC","TAB 50MG DR","30.00","Select","Select",""],["","00472040250","CLOBETASOL","SOL 0.0005","50.00","Select","Select",""],["","00378727253","NORETHINDRON","TAB 0.35MG","84.00","Select","Select",""],["","55111012701","CIPROFLOXACN","TAB 500MG","14.00","Select","Select",""],["","49281042050","FLUZONE","INJ 2020-21","0.50","Select","Select",""],["","50228014610","HYDROCHLOROT","CAP 12.5MG","90.00","Select","Select",""],["","69238158306","NORLYDA","TAB 0.35MG","28.00","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","6.00","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","6.00","Select","Select",""],["","19515081852","FLULAVAL","INJ 2021-22","0.50","Select","Select",""],["","14539067401","HYDROXYZ","CAP 25MG","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":""}]}]}