{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARY E NOLAN","gend":1,"add":"1611 SPRING AVENUE SW","city":"NORTON","state":"VA","zip":"24273-9998","dob":"1954-02-11","age":"","mstatus":"","insh":"11007252","cliId":"","pno":2762029891,"cno":"","email":"","ename":"","eno":"","pphy":"BASHAM, CHRISTOPHER M","ppno":2766790321,"pcpadd":"295 Wharton Ln NE","pcpcity":"Norton","pcpstate":"VA","pcpzip":242731541,"pcpcounty":"","pcpid":"","pcpname":"WELLMONT MEDICAL ASSOCIATES INC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1611 SPRING AVENUE SW","madd2":"","madd3":"","mcity":"NORTON","mstate":"VA","mzip":"24273-9998","pcpfaxno":"(276) 523-6719","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":[["","00093083210","CLONAZEPAM ","0.5MG","60.00","Select","Select",""],["","00093894301","ACYCLOVIR ","400MG","50.00","Select","Select",""],["","00781214801","LANSOPRAZOLE ","30MG DR","90.00","Select","Select",""],["","65162054111","CYCLOBENZAPR ","10MG","60.00","Select","Select",""],["","00378043501","BUPROPION ","100MG","60.00","Select","Select",""],["","65862020399","LOSARTAN ","100MG","90.00","Select","Select",""],["","68180012102","CEPHALEXIN ","250MG","60.00","Select","Select",""],["","00378020810","FUROSEMIDE ","20MG","180.00","Select","Select",""],["","00456120230","LINZESS ","290MCG","90.00","Select","Select",""],["","00781571001","POT  CL MICRO","10MEQ ER","90.00","Select","Select",""],["","00378001805","METOPROL ","25MG","90.00","Select","Select",""],["","00781518010","LEVOTHYROXIN ","25MCG","90.00","Select","Select",""],["","43547027609","DONEPEZIL ","10MG","90.00","Select","Select",""],["","67877022305","GABAPENTIN ","300MG","7.00","Select","Select",""],["","53885039310","ONETOUCH ","LANCETS","200.00","Select","Select",""],["","63304090530","VALACYCLOVIR ","1GM","20.00","Select","Select",""],["","00143211205","DOXYCYCL ","100MG","20.00","Select","Select",""],["","50111032501","BETHANECHOL ","25MG","270.00","Select","Select",""],["","00378520977","AMLODIPINE ","5MG","90.00","Select","Select",""],["","29300022010","MONTELUKAST ","10MG","90.00","Select","Select",""],["","68462024805","RANITIDINE ","150MG","180.00","Select","Select",""],["","16729021810","CLOPIDOGREL ","75MG","90.00","Select","Select",""],["","00378395205","ATORVASTATIN ","40MG","90.00","Select","Select",""],["","00555030204","HYDROXYZ ","50MG","270.00","Select","Select",""],["","00172572960","FAMOTIDINE ","40MG","180.00","Select","Select",""],["","57664039758","METFORMIN ","500MG","180.00","Select","Select",""],["","00310737020","BUDES\/FORMOT ","160-4.5","30.60","Select","Select",""],["","00093317431","ALBUTEROL ","E","25.50","Select","Select",""],["","00781202005","AMOXICILLIN ","250MG","30.00","Select","Select",""],["","65162083366","DICLOFENAC ","1%","100.00","Select","Select",""],["","49281012065","FLUZONE ","PF 20-21","0.70","Select","Select",""],["","43598043611","NITROGLYCERN ","0.4MG","75.00","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","48.00","Select","Select",""],["","67877025115","TRIAMCINOLON ","0.10%","30.00","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21.00","Select","Select",""],["","45802046564","KETOCONAZOLE ","2%","120.00","Select","Select",""],["","50111033401","METRONIDAZOL ","500MG","30.00","Select","Select",""],["","59310057922","PROAIR ","","25.50","Select","Select",""],["","00006483703","PNEUMOVAX ","25\/0.5","0.50","Select","Select",""],["","00378145401","ESTRADIOL ","1MG","90.00","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","LANCETS","200.00","Select","Select",""],["","55111015330","ONDANSETRON ","4MG","15.00","Select","Select",""],["","00378623305","CITALOPRAM ","40MG","90.00","Select","Select",""],["","00781577626","AZITHROMYCIN ","250MG","6.00","Select","Select",""],["","16729000201","GLIMEPIRIDE ","2MG","30.00","Select","Select",""],["","99073070822","FREESTYLE    TES LITE","LITE","150.00","Select","Select",""],["","00005197102","PREVNAR ","","0.50","Select","Select",""],["","68180098003","LISINOPRIL ","10MG","90.00","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":""}]}]}