{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHAEL SMITH","gend":0,"add":"2085 Cannady School Rd Se","city":"Floyd","state":"VA","zip":"24091-2944","dob":"1967-07-06","age":"","mstatus":"","insh":"11007399","cliId":"","pno":5405972142,"cno":"","email":"","ename":"","eno":"","pphy":"JONES, EZEKIEL N","ppno":5403454946,"pcpadd":"4461 Starkey Rd Ste 201","pcpcity":"Roanoke","pcpstate":"VA","pcpzip":240180622,"pcpcounty":"","pcpid":"","pcpname":"PHYSICIAN ASSOCIATES OF VIRGINIA PC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"2085 Cannady School Rd Se","madd2":"","madd3":"","mcity":"Floyd","mstate":"VA","mzip":"24091-2944","pcpfaxno":"(540) 375-8621","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":[["","00093738656","VENLAFAXINE ","150MG ER","30.00","Select","Select",""],["","00781207601","TAMSULOSIN ","0.4MG","30.00","Select","Select",""],["","55111015810","OMEPRAZOLE ","20MG","30.00","Select","Select",""],["","45963055650","GABAPENTIN ","300MG","180.00","Select","Select",""],["","00378111001","GLIPIZIDE ","10MG","60.00","Select","Select",""],["","29300014005","DIVALPROEX ","500MG DR","150.00","Select","Select",""],["","65162090203","ARIPIPRAZOLE ","30MG","30.00","Select","Select",""],["","69097012303","TOPIRAMATE ","50MG","62.00","Select","Select",""],["","68180051303","LISINOPRIL ","5MG","30.00","Select","Select",""],["","57664047458","METFORMIN ","1000MG","60.00","Select","Select",""],["","99073070914","FREESTYLE    KIT FREEDOM","FREEDOM","50.00","Select","Select",""],["","68180096501","LEVOTHYROXIN ","25MCG","28.00","Select","Select",""],["","65862022960","LAMOTRIGINE ","150MG","56.00","Select","Select",""],["","00378020801","FUROSEMIDE ","20MG","15.00","Select","Select",""],["","23155050110","HYDROXYZ ","25MG","90.00","Select","Select",""],["","00173071920","FLOVENT ","110MCG","12.00","Select","Select",""],["","61314001910","DORZOLAMIDE ","2% OP","10.00","Select","Select",""],["","00115165901","PROPRANOLOL ","10MG","44.00","Select","Select",""],["","60505036301","OFLOXACIN ","0.3%OTIC","10.00","Select","Select",""],["","65702040810","ACCU-CHEK ","AVIVA PL","100.00","Select","Select",""],["","50383077932","LACTULOSE ","10GM\/15","2,700.00","Select","Select",""],["","65649030302","XIFAXAN ","550MG","30.00","Select","Select",""],["","24208046325","LATANOPROST ","0.01%","2.50","Select","Select",""],["","53746010901","HYDROCO\/APAP ","5-325MG","12.00","Select","Select",""],["","64380074107","BUSPIRONE ","5MG","60.00","Select","Select",""],["","53885024510","ONETOUCH ","ULTRA","100.00","Select","Select",""],["","71699015030","XCOPRI ","150MG","90.00","Select","Select",""],["","72252052004","VALTOCO ","20MG","1.00","Select","Select",""],["","45802041954","AMMONIUM ","12%","226.00","Select","Select",""],["","50924097110","SOFTCLIX ","LANCETS","100.00","Select","Select",""],["","00093317431","ALBUTEROL ","E","8.50","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","20.00","Select","Select",""],["","67877025010","QUETIAPINE ","100MG","90.00","Select","Select",""],["","51672127502","CLOTRIMAZOLE ","1%","30.00","Select","Select",""],["","43386005019","GAVILYTE-N ","FLAV PK","4,000.00","Select","Select",""],["","53746027205","SMZ\/TMP ","800-160","20.00","Select","Select",""],["","08484070120","PRODIGY ","MONITOR","1.00","Select","Select",""],["","00536110301","ALCOHOL ","70%","100.00","Select","Select",""],["","08470046501","COMFORTOUCH ","LANCET","100.00","Select","Select",""],["","49884030802","CLONAZEP ","0.5MG","10.00","Select","Select",""],["","65862017601","PENICILLN ","500MG","28.00","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":""}]}]}