{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"APRIL D HELTON","gend":1,"add":"401 NORTH ST","city":"RICHLANDS","state":"VA","zip":"24641-9998","dob":"1985-05-08","age":"","mstatus":"","insh":"11002953","cliId":"","pno":8063899504,"cno":2763899504,"email":"","ename":"","eno":"","pphy":"GOODMAN, ASHLEY D","ppno":2769646771,"pcpadd":"295 Wharton Ln NE","pcpcity":"Norton","pcpstate":"VA","pcpzip":242731541,"pcpcounty":"","pcpid":"","pcpname":"CLINCH VALLEY PHYSICIANS ASSOCIATES LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"401 NORTH ST","madd2":"","madd3":"","mcity":"RICHLANDS","mstate":"VA","mzip":"24641-9998","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",""],["","00603243721","BENZTROPINE ","0.5MG","90.00","Select","Select",""],["","10370010250","BUPROPN ","300MG XL","90.00","Select","Select",""],["","69238207707","PROPRANOLOL ","10MG","90.00","Select","Select",""],["","68382008001","HALOPERIDOL ","10MG","90.00","Select","Select",""],["","00093310905","AMOXICILLIN ","500MG","30.00","Select","Select",""],["","00456120130","LINZESS ","145MCG","30.00","Select","Select",""],["","69097012403","TOPIRAMATE ","100MG","270.00","Select","Select",""],["","49281041950","FLUZONE ","2019-20","0.50","Select","Select",""],["","00781591601","CHLORPROMAZ ","100MG","30.00","Select","Select",""],["","50111043301","TRAZODONE ","50MG","180.00","Select","Select",""],["","33332032001","AFLURIA ","2020-21","0.50","Select","Select",""],["","72626270101","SOFOS\/VELPAT ","400-100","28.00","Select","Select",""],["","68462056435","MUPIROCIN ","2%","30.00","Select","Select",""],["","00228300411","CLONAZEPAM ","1MG","30.00","Select","Select",""],["","70461032103","FLUCLVX ","2021-22","0.50","Select","Select",""],["","00093221001","SUCRALFATE ","1GM","360.00","Select","Select",""],["","00115521116","COLESTIPOL ","1GM","180.00","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","20.00","Select","Select",""],["","00093742698","MONTELUKAST ","10MG","30.00","Select","Select",""],["","24658031205","DOXYCYCL ","100MG","20.00","Select","Select",""],["","63304069301","CLINDAMYCIN ","300MG","40.00","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","40.00","Select","Select",""],["","00378064205","PREDNISONE ","20MG","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":""}]}]}