{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RALPH SMITHSON","gend":0,"add":"3584 RIDGE CREEK RD","city":"KEOKEE","state":"VA","zip":"24265-9998","dob":"1957-02-18","age":"","mstatus":"","insh":"11009594","cliId":"","pno":2765463541,"cno":"","email":"","ename":"","eno":"","pphy":"ECHEVERRIA, JOSE M","ppno":6065734520,"pcpadd":"37 Ball Park Rd","pcpcity":"Harlan","pcpstate":"KY","pcpzip":408311701,"pcpcounty":"","pcpid":"","pcpname":"ARH PENNINGTON GAP CLINIC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"3584 RIDGE CREEK RD","madd2":"","madd3":"","mcity":"KEOKEE","mstate":"VA","mzip":"24265-9998","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":[["","00406012305","HYDROCO\/APAP ","5-325MG","60.00","Select","Select",""],["","69097094312","GABAPENTIN ","300MG","90.00","Select","Select",""],["","69238183007","LEVOTHYROXIN ","25MCG","90.00","Select","Select",""],["","00378395305","ATORVASTATIN ","80MG","90.00","Select","Select",""],["","27241011703","FENOFIBRATE ","160MG","90.00","Select","Select",""],["","55111018015","TIZANIDINE ","4MG","90.00","Select","Select",""],["","55111019605","CLOPIDOGREL ","75MG","90.00","Select","Select",""],["","68180051703","LISINOPRIL ","40MG","90.00","Select","Select",""],["","67877056305","METFORMIN ","1000MG","180.00","Select","Select",""],["","60505014102","GLIPIZIDE ","5MG","30.00","Select","Select",""],["","57237004105","PENICILLN ","500MG","41.00","Select","Select",""],["","68382056401","METOPROL ","25MG ER","90.00","Select","Select",""],["","60505317007","OMEGA-3-ACID ","1GM","180.00","Select","Select",""],["","61442017130","CEFACLOR ","250MG","21.00","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","",""],[""],[""],[""],[""]],"comment":[["","",""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}