{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ARYETTA M DOOLEY","gend":1,"add":"3445 BICHLAWN AVE NW","city":"ROANOKE","state":"VA","zip":"24012-9998","dob":"1950-12-07","age":"","mstatus":"","insh":"11001345","cliId":"","pno":5404943750,"cno":"","email":"","ename":"","eno":"","pphy":"KEILMAN, DAVID A","ppno":5402651607,"pcpadd":"4910 Valley View Blvd Nw Ste 10","pcpcity":"Roanoke","pcpstate":"VA","pcpzip":240122040,"pcpcounty":"","pcpid":"","pcpname":"LEWIS GALE PHYSICIANS LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"3445 BICHLAWN AVE NW","madd2":"","madd3":"","mcity":"ROANOKE","mstate":"VA","mzip":"24012-9998","pcpfaxno":"(540) 772-6441","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":[["","16714008402","SPIRONOLACT ","25MG","30.00","Select","Select",""],["","16714084401","AMIODARONE ","200MG","30.00","Select","Select",""],["","16714087502","ATORVASTATIN ","20MG","30.00","Select","Select",""],["","00406012505","HYDROCO\/APAP ","10-325MG","180.00","Select","Select",""],["","43547040211","FUROSEMIDE ","40MG","30.00","Select","Select",""],["","57841130001","MOVANTIK ","12.5MG","30.00","Select","Select",""],["","59762033302","LATANOPROST ","0.01%","2.50","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","20.00","Select","Select",""],["","59385004130","SYMPROIC ","0.2MG","30.00","Select","Select",""],["","00003089421","ELIQUIS ","5MG","60.00","Select","Select",""],["","00185067405","HYDROXYZ ","25MG","90.00","Select","Select",""],["","10702000350","PROMETHAZINE ","25MG","20.00","Select","Select",""],["","10702005601","OXYCODONE ","10MG","15.00","Select","Select",""],["","59385002360","BELBUCA ","300MCG","10.00","Select","Select",""],["","58914017014","CARAFATE ","1GM\/10ML","600.00","Select","Select",""],["","64764024060","AMITIZA ","24MCG","10.00","Select","Select",""],["","00456120130","LINZESS ","145MCG","30.00","Select","Select",""],["","52817033200","CYCLOBENZAPR ","10MG","30.00","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","20.00","Select","Select",""],["","23155013525","DOXYCYC ","100MG","20.00","Select","Select",""],["","31722071390","PANTOPRAZOLE ","40MG","30.00","Select","Select",""],["","68462010530","ONDANSETRON ","4MG","21.00","Select","Select",""],["","65162010250","GABAPENTIN ","300MG","90.00","Select","Select",""],["","53489011802","DOXYCYCL ","50MG","30.00","Select","Select",""],["","65597030110","MORPHABOND ","15MG ER","6.00","Select","Select",""],["","00172572860","FAMOTIDINE ","20MG","60.00","Select","Select",""],["","00603533815","PREDNISONE ","10MG","21.00","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","21.00","Select","Select",""],["","59651006605","OLOPATADINE ","0.20%","2.50","Select","Select",""],["","42858049340","BUPRENORPHIN ","10MCG\/HR","4.00","Select","Select",""],["","00574402435","ERYTHROMYCIN ","5MG\/GM","3.50","Select","Select",""],["","00143992801","CIPROFLOXACN ","500MG","14.00","Select","Select",""],["","00591079501","DICYCLOMINE ","20MG","120.00","Select","Select",""],["","24208079535","NEO\/POLY\/DEX ","0.1% OP","3.50","Select","Select",""],["","13811071910","NITROFURANTN ","100MG","14.00","Select","Select",""],["","64980034003","ALENDRONATE ","10MG","90.00","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":""}]}]}