{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SANDRA A SANDERSON","gend":1,"add":"1144 WHISTLESTOP WAY","city":"HUDDLESTON","state":"VA","zip":"24104-9998","dob":"1963-06-01","age":"","mstatus":"","insh":"11013999","cliId":"","pno":5408744286,"cno":8043335518,"email":"","ename":"","eno":"","pphy":"BLANKS, VIRGINIA L","ppno":5402977181,"pcpadd":"4830 Rucker Rd","pcpcity":"Moneta","pcpstate":"VA","pcpzip":241215281,"pcpcounty":"","pcpid":"","pcpname":"VILLAGE FAMILY PHYSICIANS INC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1144 WHISTLESTOP WAY","madd2":"","madd3":"","mcity":"HUDDLESTON","mstate":"VA","mzip":"24104-9998","pcpfaxno":"(434) 200-1700","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":[["","45802008801","ALBUTEROL ","HFA","25.50","Select","Select",""],["","69315090505","LORAZEPAM ","1MG","30.00","Select","Select",""],["","00173088710","TRELEGY ","ELLIPTA","180.00","Select","Select",""],["","53746010901","HYDROCO\/APAP ","5-325MG","20.00","Select","Select",""],["","00310461612","BREZTRI ","SPHERE","10.70","Select","Select",""],["","00310009530","DALIRESP ","500MCG","30.00","Select","Select",""],["","55111017915","TIZANIDINE ","2MG","90.00","Select","Select",""],["","57237007730","ONDANSETRON ","4MG ODT","30.00","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16.00","Select","Select",""],["","55513071001","PROLIA ","60MG\/ML","1.00","Select","Select",""],["","59651000305","OMEPRAZOLE ","40MG","90.00","Select","Select",""],["","65862056099","PANTOPRAZOLE ","40MG","60.00","Select","Select",""],["","68382005101","MELOXICAM ","15MG","30.00","Select","Select",""],["","53489011905","DOXYCYCL ","100MG","14.00","Select","Select",""],["","00378064110","PREDNISONE ","10MG","32.00","Select","Select",""],["","00527058601","DICYCLOMINE ","10MG","240.00","Select","Select",""],["","59310057922","PROAIR ","","25.50","Select","Select",""],["","29300022019","MONTELUKAST ","10MG","90.00","Select","Select",""],["","00115168974","BUDESONIDE ","0.5MG\/2","180.00","Select","Select",""],["","50111078810","AZITHROMYCIN ","500MG","7.00","Select","Select",""],["","45963055650","GABAPENTIN ","300MG","90.00","Select","Select",""],["","43547022610","METHOCARBAM ","750MG","90.00","Select","Select",""],["","59762135101","PREGABALIN ","150MG","60.00","Select","Select",""],["","00378967130","IPRATROPIUM\/ ","ALBUTER","270.00","Select","Select",""],["","65862050320","AMOX\/K ","875-125","20.00","Select","Select",""],["","55111028050","LEVOFLOXACIN ","500MG","10.00","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":""}]}]}