{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VIRGINIA RINEHOLT","gend":1,"add":"60 THREE FORKS LANE","city":"WIRTZ","state":"VA","zip":"24184-4247","dob":"1982-07-23","age":"","mstatus":"","insh":"11002795","cliId":"","pno":5404932299,"cno":"","email":"","ename":"","eno":"","pphy":"IRBY, SUSAN","ppno":5407212689,"pcpadd":"13205 Booker T Washington Hwy","pcpcity":"Hardy","pcpstate":"VA","pcpzip":241013947,"pcpcounty":"","pcpid":"","pcpname":"CARILION INTERNAL MEDICINE WESTLAKE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"APARTMENT B","add3":"","madd1":"4228 Franklin St","madd2":"","madd3":"","mcity":"Rocky Mount","mstate":"VA","mzip":"24151-5360","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":[["","50111064801","FLUOXETINE ","20MG","30.00","Select","Select",""],["","65862066130","ARIPIPRAZOLE ","2MG","30.00","Select","Select",""],["","59310057922","PROAIR ","","8.50","Select","Select",""],["","52536018603","ERYTHROMYCIN ","500MG EC","120.00","Select","Select",""],["","55111029136","SUMATRIPTAN ","25MG","27.00","Select","Select",""],["","59651000305","OMEPRAZOLE ","40MG","90.00","Select","Select",""],["","50111056101","TRAZODONE ","100MG","30.00","Select","Select",""],["","00054429731","FUROSEMIDE ","20MG","90.00","Select","Select",""],["","65162052110","PROMETHAZINE ","25MG","30.00","Select","Select",""],["","00093317431","ALBUTEROL ","E","8.50","Select","Select",""],["","47781030301","NITROFURANTN ","100MG","10.00","Select","Select",""],["","59746011506","PROCHLORPER ","10MG","30.00","Select","Select",""],["","00591294430","PIMECROLIMUS ","1%","30.00","Select","Select",""],["","65162044210","MECLIZINE ","25MG","270.00","Select","Select",""],["","00472033720","HYDROCORT ","2.50%","20.00","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","20.00","Select","Select",""],["","00406055201","OXYCODONE ","5MG","20.00","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","48.00","Select","Select",""],["","55111012701","CIPROFLOXACN ","500MG","20.00","Select","Select",""],["","63304069301","CLINDAMYCIN ","300MG","28.00","Select","Select",""],["","00591299801","URSODIOL ","250MG","180.00","Select","Select",""],["","65162006205","SUCRALFATE ","1GM\/10ML","400.00","Select","Select",""],["","53746010901","HYDROCO\/APAP ","5-325MG","12.00","Select","Select",""],["","51672416403","METRONIDAZOL ","1%","60.00","Select","Select",""],["","24208031510","POLYMYXIN ","TRIMETHP","10.00","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":""}]}]}