{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHARON D SEXTON","gend":1,"add":"741 NORTHVIEW STREET","city":"NARROWS","state":"VA","zip":"24124-9998","dob":"1961-11-15","age":"","mstatus":"","insh":"11007395","cliId":"","pno":5405992261,"cno":"","email":"","ename":"","eno":"","pphy":"LOUGH, ANDREA R","ppno":5409859820,"pcpadd":"1611 Wenonah Ave","pcpcity":"Pearisburg","pcpstate":"VA","pcpzip":241341839,"pcpcounty":"","pcpid":"","pcpname":"CARILION FAMILY MEDICINE GILES COUNTY","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"PO BOX 62","madd2":"","madd3":"","mcity":"NARROWS","mstate":"VA","mzip":"24124-9998","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":[["","76204060030","IPRATROPIUM\/ ","ALBUTER","270.00","Select","Select",""],["","29300016915","TIZANIDINE ","4MG","180.00","Select","Select",""],["","00173069600","ADVAIR ","250\/50","60.00","Select","Select",""],["","50111091701","TORSEMIDE ","20MG","180.00","Select","Select",""],["","00574018101","POT  CHLORIDE","10MEQ ER","90.00","Select","Select",""],["","72205000490","ROSUVASTATIN ","20MG","90.00","Select","Select",""],["","31722071390","PANTOPRAZOLE ","40MG","90.00","Select","Select",""],["","00003089421","ELIQUIS ","5MG","180.00","Select","Select",""],["","59746038406","TERAZOSIN ","2MG","90.00","Select","Select",""],["","24979002902","DILTIAZEM ","300MG ER","90.00","Select","Select",""],["","53885099425","ONETOUCH ","ULTRA BL","200.00","Select","Select",""],["","62037060005","CARTIA ","300\/24HR","90.00","Select","Select",""],["","00185505001","METOLAZONE ","2.5MG","12.00","Select","Select",""],["","69238110002","DOXYCYCL ","100MG","14.00","Select","Select",""],["","00054429931","FUROSEMIDE ","40MG","270.00","Select","Select",""],["","53746051401","SPIRONOLACT ","50MG","180.00","Select","Select",""],["","64380080438","RANITIDINE ","300MG","90.00","Select","Select",""],["","00193654621","BAYER ","LANCETS","100.00","Select","Select",""],["","16714003902","COLCHICINE ","0.6MG","180.00","Select","Select",""],["","16714004107","ALLOPURINOL ","100MG","270.00","Select","Select",""],["","72305017530","EUTHYROX ","175MCG","30.00","Select","Select",""],["","29300022019","MONTELUKAST ","10MG","90.00","Select","Select",""],["","00186037020","SYMBICORT ","160-4.5","10.20","Select","Select",""],["","59746017509","PREDNISONE ","20MG","15.00","Select","Select",""],["","62559038101","FLECAINIDE ","100MG","60.00","Select","Select",""],["","63304069201","CLINDAMYCIN ","150MG","63.00","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16.00","Select","Select",""],["","00074707090","SYNTHROID ","175MCG","30.00","Select","Select",""],["","69238183901","LEVOTHYROXIN ","175MCG","30.00","Select","Select",""],["","65862018730","ONDANSETRON ","4MG","60.00","Select","Select",""],["","00310737020","BUDES\/FORMOT ","160-4.5","10.20","Select","Select",""],["","43598043611","NITROGLYCERN ","0.4MG","25.00","Select","Select",""],["","68180096301","ALBUTEROL ","HFA","8.50","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0.50","Select","Select",""],["","00378932132","WIXELA ","250\/50","60.00","Select","Select",""],["","50111078751","AZITHROMYCIN ","250MG","6.00","Select","Select",""],["","65862044830","VALACYCLOVIR ","500MG","28.00","Select","Select",""],["","65862057290","VALSARTAN ","160MG","90.00","Select","Select",""],["","67877021660","CEFUROXIME ","500MG","14.00","Select","Select",""],["","64764017530","DEXILANT ","60MG DR","30.00","Select","Select",""],["","70700026330","LANSOPRAZOLE ","30MG DR","90.00","Select","Select",""],["","00093735201","CALCITRIOL ","0.25MCG","39.00","Select","Select",""],["","00406324301","HYDROMORPHON ","2MG","20.00","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":""}]}]}