{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MELISSA L SALTERS","gend":1,"add":"129 OTTER AVE","city":"SALEM","state":"VA","zip":"24153-9998","dob":"1971-07-29","age":"","mstatus":"","insh":"11014233","cliId":"","pno":5406327063,"cno":"","email":"","ename":"","eno":"","pphy":"BLASKIS, WILLIAM JOSEPH","ppno":5403895093,"pcpadd":"150 Spartan Dr","pcpcity":"Salem","pcpstate":"VA","pcpzip":241533208,"pcpcounty":"","pcpid":"","pcpname":"CARILION CLINIC FAMILY MEDICINE SALEM","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"APT 140","add3":"","madd1":"129 OTTER AVE","madd2":"APT 140","madd3":"","mcity":"SALEM","mstate":"VA","mzip":"24153-9998","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":[["","43598029890","PREGABALIN ","300MG","30.00","Select","Select",""],["","00378668977","PANTOPRAZOLE ","40MG","90.00","Select","Select",""],["","57664047758","METOPROL ","50MG","60.00","Select","Select",""],["","08290320119","BD  PEN NEEDL","31GX5MM","100.00","Select","Select",""],["","68180051202","LISINOPRIL ","2.5MG","60.00","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","90.00","Select","Select",""],["","59310057922","PROAIR ","","8.50","Select","Select",""],["","70010075401","METHOCARBAM ","500MG","120.00","Select","Select",""],["","45802004835","NYSTATIN ","100000","15.00","Select","Select",""],["","00115174801","METAXALONE ","800MG","90.00","Select","Select",""],["","52817033200","CYCLOBENZAPR ","10MG","90.00","Select","Select",""],["","68462016305","CARVEDILOL ","6.25MG","180.00","Select","Select",""],["","00093317431","ALBUTEROL ","E","8.50","Select","Select",""],["","61314063705","PREDNISOLONE ","1% OP","15.00","Select","Select",""],["","70010049105","METFORMIN ","ORAL TAB","30.00","Select","Select",""],["","00781707787","METRONIDAZOL ","0.75%VAG","70.00","Select","Select",""],["","00527133001","BACLOFEN ","10MG","90.00","Select","Select",""],["","00169406012","VICTOZA ","18MG\/3ML","12.00","Select","Select",""],["","23155050001","HYDROXYZ ","10MG","90.00","Select","Select",""],["","65862052790","VENLAFAXINE ","37.5 ER","60.00","Select","Select",""],["","00406048410","APAP\/CODEINE ","300-30MG","6.00","Select","Select",""],["","42799011101","ETODOLAC ","400MG","60.00","Select","Select",""],["","58160088552","FLUARIX ","2020-21","0.50","Select","Select",""],["","00591352530","LIDOCAINE ","5%","60.00","Select","Select",""],["","68462010805","TOPIRAMATE ","25MG","30.00","Select","Select",""],["","47335032688","NALTREXONE ","50MG","30.00","Select","Select",""],["","69097052444","DICLOFENAC ","1%","100.00","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":""}]}]}