{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ADELEE ELDER","gend":1,"add":"1150 EPPERLY MILL ROAD","city":"FLOYD","state":"VA","zip":"24091-3306","dob":"1987-03-01","age":"","mstatus":"","insh":"11014318","cliId":"","pno":5402676645,"cno":"","email":"","ename":"","eno":"","pphy":"KUIKEN, GARRY","ppno":5407455700,"pcpadd":"249 Franklin Pike SE","pcpcity":"Floyd","pcpstate":"VA","pcpzip":240912893,"pcpcounty":"","pcpid":"","pcpname":"CARILION CLINIC PRIMARY CARE ASSOCIATES FLOYD","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1150 EPPERLY MILL ROAD","madd2":"","madd3":"","mcity":"FLOYD","mstate":"VA","mzip":"24091-3306","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":[["","00555057235","METHOTREXATE ","2.5MG","24.00","Select","Select",""],["","43547028110","ESCITALOPRAM ","10MG","30.00","Select","Select",""],["","55111015810","OMEPRAZOLE ","20MG","90.00","Select","Select",""],["","65162075750","DIVALPROEX ","500MG ER","90.00","Select","Select",""],["","50474071079","CIMZIA ","200MG\/ML","1.00","Select","Select",""],["","69097082212","CITALOPRAM ","10MG","30.00","Select","Select",""],["","00143211205","DOXYCYCL ","100MG","20.00","Select","Select",""],["","67877021905","CEPHALEXIN ","500MG","14.00","Select","Select",""],["","51672131200","MUPIROCIN ","2%","22.00","Select","Select",""],["","64380074207","BUSPIRONE ","10MG","120.00","Select","Select",""],["","00054414622","CLOTRIMAZOLE ","10MG","4.00","Select","Select",""],["","65862018601","CLINDAMYCIN ","300MG","28.00","Select","Select",""],["","65162077810","BUDESONIDE ","3MG DR","30.00","Select","Select",""],["","43386035610","HYDROCO\/APAP ","5-325MG","12.00","Select","Select",""],["","57237000511","FLUCONAZOLE ","150MG","2.00","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":""}]}]}