{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHERRY ELSWICK","gend":1,"add":"1063 EMMITT RD","city":"BIG ROCK","state":"VA","zip":"24603-9998","dob":"1952-08-14","age":"","mstatus":"","insh":"11007915","cliId":"","pno":2765300068,"cno":"","email":"","ename":"","eno":"","pphy":"SUTHERLAND, CLINTON H","ppno":2766795874,"pcpadd":"24530 Falcon Place Blvd Ste 102","pcpcity":"Abingdon","pcpstate":"VA","pcpzip":242117665,"pcpcounty":"","pcpid":"","pcpname":"WELLMONT MEDICAL ASSOCIATES INC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"PO BOX 182","madd2":"","madd3":"","mcity":"BIG ROCK","mstate":"VA","mzip":"24603-9998","pcpfaxno":"(276) 628-4906","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":[["","00168025846","CLOTRIM\/BETA ","DIPROP","45.00","Select","Select",""],["","69097068205","PREGABALIN ","150MG","60.00","Select","Select",""],["","00406012505","HYDROCO\/APAP ","10-325MG","90.00","Select","Select",""],["","00603254428","BUT\/APAP\/CAF ","","30.00","Select","Select",""],["","65862032804","ALENDRONATE ","35MG","12.00","Select","Select",""],["","68462025301","ROPINIROLE ","0.25MG","90.00","Select","Select",""],["","65862052790","VENLAFAXINE ","37.5 ER","90.00","Select","Select",""],["","68180072103","AMLODIPINE ","10MG","90.00","Select","Select",""],["","43386033001","TRIMETHOPRIM ","100MG","30.00","Select","Select",""],["","60505257908","ATORVASTATIN ","20MG","90.00","Select","Select",""],["","00228212750","CLONIDINE ","0.1MG","180.00","Select","Select",""],["","23155077201","ENALAPRIL ","10MG","180.00","Select","Select",""],["","43598071901","CHLORTHALID ","25MG","90.00","Select","Select",""],["","16729044917","LEVOTHYROXIN ","75MCG","90.00","Select","Select",""],["","62175013643","OMEPRAZOLE ","40MG","90.00","Select","Select",""],["","65862035705","CLOPIDOGREL ","75MG","30.00","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","20.00","Select","Select",""],["","31722071390","PANTOPRAZOLE ","40MG","90.00","Select","Select",""],["","00071101668","LYRICA ","150MG","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":""}]}]}