{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHRISTIE C SUTHERLAND","gend":1,"add":"697 WOOD CREST ROAD","city":"MOUTH OF WILSON","state":"VA","zip":"24363-9998","dob":"1979-09-26","age":"","mstatus":"","insh":"11002890","cliId":"","pno":2765797340,"cno":2767687206,"email":"","ename":"","eno":"","pphy":"JUDY, CHARLES","ppno":5406395300,"pcpadd":"600 Randolph St","pcpcity":"Radford","pcpstate":"VA","pcpzip":241412428,"pcpcounty":"","pcpid":"","pcpname":"FAMILY HEALTH CLINIC INC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"697 WOOD CREST ROAD","madd2":"","madd3":"","mcity":"MOUTH OF WILSON","mstate":"VA","mzip":"24363-9998","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":[]},{"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":[["","62175061743","PANTOPRAZOLE ","40MG","60.00","Select","Select",""],["","13107008405","LORAZEPAM ","1MG","90.00","Select","Select",""],["","69097084507","CYCLOBENZAPR ","5MG","30.00","Select","Select",""],["","61874014530","VRAYLAR ","4.5MG","90.00","Select","Select",""],["","43547040711","CLONAZEPAM ","1MG","90.00","Select","Select",""],["","67877022005","CEPHALEXIN ","250MG","28.00","Select","Select",""],["","69097094312","GABAPENTIN ","300MG","90.00","Select","Select",""],["","00228202950","ALPRAZOLAM ","0.5MG","90.00","Select","Select",""],["","16714045302","QUETIAPINE ","50MG","30.00","Select","Select",""],["","70954000520","OXYBUTYNIN ","5MG","28.00","Select","Select",""],["","69547035302","NARCAN ","","2.00","Select","Select",""],["","64764075030","TRINTELLIX ","20MG","30.00","Select","Select",""],["","69584061250","METHOCARBAM ","750MG","21.00","Select","Select",""],["","31722070430","VALACYCLOVIR ","500MG","14.00","Select","Select",""],["","10702000310","PROMETHAZINE ","25MG","30.00","Select","Select",""],["","55111046705","METOPROL ","50MG ER","30.00","Select","Select",""],["","00143928501","AMOXICILLIN ","875MG","20.00","Select","Select",""],["","31722053712","LEVETIRACETA ","500MG","90.00","Select","Select",""],["","65162027250","SMZ\/TMP ","800-160","14.00","Select","Select",""],["","69543038810","KETOROLAC ","10MG","28.00","Select","Select",""],["","70710113908","FLUCONAZOLE ","150MG","3.00","Select","Select",""],["","59762444002","METHYLPRED ","4MG","21.00","Select","Select",""],["","50111078751","AZITHROMYCIN ","250MG","6.00","Select","Select",""],["","00172392670","DIAZEPAM ","5MG","90.00","Select","Select",""],["","16714065102","CIPROFLOXACN ","250MG","10.00","Select","Select",""],["","00527128210","DICYCLOMINE ","20MG","20.00","Select","Select",""],["","60505327503","OLANZAPINE ","5MG ODT","30.00","Select","Select",""],["","59310057922","PROAIR ","","8.50","Select","Select",""],["","33342002208","LEVOFLOXACIN ","500MG","10.00","Select","Select",""],["","00074262528","MAVYRET ","100-40MG","84.00","Select","Select",""],["","65862019301","FLUOXETINE ","20MG","30.00","Select","Select",""],["","49281063315","FLUZONE ","2020-21","0.50","Select","Select",""],["","00093317431","ALBUTEROL ","E","8.50","Select","Select",""],["","00115168774","BUDESONIDE ","0.25MG\/2","120.00","Select","Select",""],["","53746010901","HYDROCO\/APAP ","5-325MG","9.00","Select","Select",""],["","68382079201","ACYCLOVIR ","800MG","35.00","Select","Select",""],["","24208091055","ERYTHROMYCIN ","5MG\/GM","3.50","Select","Select",""],["","63402030630","LATUDA ","60MG","30.00","Select","Select",""],["","16729017601","AMITRIPTYLIN ","150MG","30.00","Select","Select",""],["","62756018388","OXCARBAZEPIN ","150MG","30.00","Select","Select",""],["","16714071302","TAMSULOSIN ","0.4MG","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":""}]}]}