{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DELORA L WOOD","gend":1,"add":"23775 DICKENSON HIGHWAY","city":"HAYSI","state":"VA","zip":"24256-9998","dob":"1934-06-14","age":"","mstatus":"","insh":"11006550","cliId":"","pno":2763452052,"cno":2768654156,"email":"","ename":"","eno":"","pphy":"KEENE, MELISSA NICOLE","ppno":2769351760,"pcpadd":"162 Medical Center","pcpcity":"HAYSI","pcpstate":"VA","pcpzip":242561000,"pcpcounty":"","pcpid":"","pcpname":"HAYSI CLINIC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"23775 DICKENSON HIGHWAY","madd2":"","madd3":"","mcity":"HAYSI","mstate":"VA","mzip":"24256-9998","pcpfaxno":"(276) 546-9707","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":[["","57664037718","TRAMADOL ","50MG","20.00","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","90.00","Select","Select",""],["","59762372104","ALPRAZOLAM ","1MG","60.00","Select","Select",""],["","60505083305","AZELASTINE ","0.10%","30.00","Select","Select",""],["","68001011203","LANSOPRAZOLE ","30MG DR","30.00","Select","Select",""],["","68001044500","POT  CHLORIDE","20MEQ ER","15.00","Select","Select",""],["","68001033408","LISINOPRIL ","10MG","30.00","Select","Select",""],["","16729018317","HYDROCHLOROT ","25MG","30.00","Select","Select",""],["","45802008801","ALBUTEROL ","HFA","8.50","Select","Select",""],["","68001035603","METOPROL ","25MG ER","60.00","Select","Select",""],["","16729011917","MONTELUKAST ","10MG","30.00","Select","Select",""],["","68001023503","POT  CL MICRO","20MEQ ER","30.00","Select","Select",""],["","50383077916","LACTULOSE ","10GM\/15","473.00","Select","Select",""],["","59310057922","PROAIR ","","8.50","Select","Select",""],["","00065427325","PAZEO ","0.70%","2.50","Select","Select",""],["","45802006335","TRIAMCINOLON ","0.03%","15.00","Select","Select",""],["","62332000271","FAMOTIDINE ","40MG","14.00","Select","Select",""],["","57237007530","ONDANSETRON ","4MG","12.00","Select","Select",""],["","61314012605","KETOROLAC ","0.50%","5.00","Select","Select",""],["","55111012701","CIPROFLOXACN ","500MG","20.00","Select","Select",""],["","68001036500","METRONIDAZOL ","500MG","20.00","Select","Select",""],["","65862053750","LEVOFLOXACIN ","500MG","7.00","Select","Select",""],["","00378161001","DICYCLOMINE ","10MG","40.00","Select","Select",""],["","43386005019","GAVILYTE-N ","FLAV PK","4,000.00","Select","Select",""],["","52817031910","BACLOFEN ","5MG","60.00","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":""}]}]}