{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TRINA M ROBINSON","gend":1,"add":"127 WILSON AVENUE","city":"GALAX","state":"VA","zip":"24333-9998","dob":"1970-06-11","age":"","mstatus":"","insh":"11005718","cliId":"","pno":2762331398,"cno":2762377399,"email":"","ename":"","eno":"","pphy":"CLARK, KENNETH A","ppno":2766703300,"pcpadd":"1107 Brookdale St","pcpcity":"Martinsville","pcpstate":"VA","pcpzip":241124501,"pcpcounty":"","pcpid":"","pcpname":"CARILION MEDICAL ASSOCIATES GALAX FAMILY","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"APT 10","add3":"","madd1":"127 WILSON AVENUE","madd2":"APT 10","madd3":"","mcity":"GALAX","mstate":"VA","mzip":"24333-9998","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":[["","65162089129","MOMETASONE ","50MCG","17.00","Select","Select",""],["","53885024510","ONETOUCH ","ULTRA","100.00","Select","Select",""],["","50111064701","FLUOXETINE ","10MG","30.00","Select","Select",""],["","68382075810","METFORMIN ","500MG","180.00","Select","Select",""],["","51672404806","CLOTRIM\/BETA ","DIPROP","45.00","Select","Select",""],["","49884064001","METHIMAZOLE ","5MG","90.00","Select","Select",""],["","68180051303","LISINOPRIL ","5MG","45.00","Select","Select",""],["","00555030202","HYDROXYZ ","50MG","30.00","Select","Select",""],["","43547030303","ARIPIPRAZOLE ","5MG","30.00","Select","Select",""],["","43547033906","RISPERIDONE ","0.25MG","30.00","Select","Select",""],["","00603243721","BENZTROPINE ","0.5MG","180.00","Select","Select",""],["","59148001971","ABILIFY ","400MG","1.00","Select","Select",""],["","00093226301","AMOXICILLIN ","500MG","30.00","Select","Select",""],["","50111056001","TRAZODONE ","50MG","30.00","Select","Select",""],["","69097081312","GABAPENTIN ","100MG","90.00","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","40.00","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":""}]}]}