{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHARLES E HAYSLETT","gend":0,"add":"1083 FALLON DRIVE","city":"VINTON","state":"VA","zip":"24179-9998","dob":"1930-03-08","age":"","mstatus":"","insh":"11008182","cliId":"","pno":5408905616,"cno":"","email":"","ename":"","eno":"","pphy":"GARDNER, JAMES H","ppno":5403454946,"pcpadd":"4461 Starkey Rd Ste 201","pcpcity":"Roanoke","pcpstate":"VA","pcpzip":240180622,"pcpcounty":"","pcpid":"","pcpname":"PHYSICIAN ASSOCIATES OF VIRGINIA","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1083 FALLON DRIVE","madd2":"","madd3":"","mcity":"VINTON","mstate":"VA","mzip":"24179-9998","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":[["","68180096703","LEVOTHYROXIN ","75MCG","90.00","Select","Select",""],["","16714044402","ENALAPRIL ","10MG","90.00","Select","Select",""],["","16714087502","ATORVASTATIN ","20MG","90.00","Select","Select",""],["","16729000216","GLIMEPIRIDE ","2MG","90.00","Select","Select",""],["","56151146304","TRUE ","GLUCOSE","50.00","Select","Select",""],["","16714070701","MIRTAZAPINE ","15MG","30.00","Select","Select",""],["","43547040111","FUROSEMIDE ","20MG","90.00","Select","Select",""],["","43547026910","ROPINIROLE ","0.5MG","90.00","Select","Select",""],["","45802016000","DICLOFENAC ","1%","100.00","Select","Select",""],["","50383023310","DORZOL\/TIMOL ","22.3-6.8","10.00","Select","Select",""],["","16714049601","CLOTRIM\/BETA ","1-0.05%","30.00","Select","Select",""],["","00093221005","SUCRALFATE ","1GM","360.00","Select","Select",""],["","61314054701","LATANOPROST ","0.01%","2.50","Select","Select",""],["","58914017014","CARAFATE ","1GM\/10ML","400.00","Select","Select",""],["","68462016305","CARVEDILOL ","6.25MG","180.00","Select","Select",""],["","65862056099","PANTOPRAZOLE ","40MG","180.00","Select","Select",""],["","42385090410","METFORMIN ","500MG","90.00","Select","Select",""],["","70461012003","FLUAD ","0.5ML","0.50","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":""}]}]}