{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DONNA S BRANDVOLD","gend":1,"add":"557 ASHTON AVENUE","city":"FRANKLIN","state":"VA","zip":"23851-2001","dob":"1958-11-11","age":"","mstatus":"","insh":"11001679","cliId":"","pno":7576154967,"cno":7579494888,"email":"","ename":"","eno":"","pphy":"CALDRONEY, RALPH D","ppno":5404583344,"pcpadd":"1 Health Cir","pcpcity":"Lexington","pcpstate":"VA","pcpzip":244502448,"pcpcounty":"","pcpid":"","pcpname":"CARILION FAMILY MEDICINE LEXINGTON","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"LOT A-1","add3":"","madd1":"557 ASHTON AVENUE","madd2":"LOT A-1","madd3":"","mcity":"FRANKLIN","mstate":"VA","mzip":"23851-2001","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":[["","68180035302","SERTRALINE ","100MG","90.00","Select","Select",""],["","08463510301","INFINITY ","SYSTEM","1.00","Select","Select",""],["","60913000601","ALCOHOL ","","100.00","Select","Select",""],["","13668011510","LOSARTAN ","100MG","30.00","Select","Select",""],["","69097045805","FENOFIBRATE ","145MG","30.00","Select","Select",""],["","13668000701","ZOLPIDEM ","5MG","30.00","Select","Select",""],["","68180096301","ALBUTEROL ","HFA","8.50","Select","Select",""],["","13668010401","ISOSORB ","30MG ER","30.00","Select","Select",""],["","55111015930","OMEPRAZOLE ","40MG","90.00","Select","Select",""],["","16729017217","AMITRIPTYLIN ","25MG","30.00","Select","Select",""],["","68645056854","ATORVASTATIN ","40MG","90.00","Select","Select",""],["","68645058259","METFORMIN ","500MG","60.00","Select","Select",""],["","16714043901","NITROFURANTN ","100MG","10.00","Select","Select",""],["","00310461612","BREZTRI ","SPHERE","10.70","Select","Select",""],["","60913000301","LANCING ","","1.00","Select","Select",""],["","43598043611","NITROGLYCERN ","0.4MG","100.00","Select","Select",""],["","00093075210","ATENOLOL ","50MG","2.00","Select","Select",""],["","00310460012","BEVESPI ","9-4.8MCG","10.70","Select","Select",""],["","68308015215","NYSTATIN ","100000","60.00","Select","Select",""],["","59310057922","PROAIR ","","8.50","Select","Select",""],["","64380080307","RANITIDINE ","150MG","180.00","Select","Select",""],["","29300011516","TOPIRAMATE ","25MG","30.00","Select","Select",""],["","00469260130","MYRBETRIQ ","25MG","30.00","Select","Select",""],["","68462015713","ONDANSETRON ","4MG ODT","14.00","Select","Select",""],["","00487020103","IPRATROPIUM\/ ","ALBUTER","90.00","Select","Select",""],["","55111029209","SUMATRIPTAN ","50MG","9.00","Select","Select",""],["","00832046560","NYAMYC ","100000","60.00","Select","Select",""],["","59746012106","MECLIZINE ","25MG","20.00","Select","Select",""],["","68645051054","HYDROCHLOROT ","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":["",""],"sub":{"indx":[["","",""],[""],[""],[""],[""]],"comment":[["","",""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}